Akuezunkpa O. Welcome, MD; Dennis L. Fowler, MD, FACS
A 70 year old woman with a prior history of acute gallstone pancreatitis, presented to the office complaining of early satiety and abdominal distension. Four months prior, she was admitted to an outside hospital with the diagnosis of acute gallstone pancreatitis. An abdominal CT demonstrated multiple large peri-pancreatic fluid collections. After a month of hospitalization, the patient was discharged home. Over the ensuing months she continued to feel bloated. A repeat CT scan demonstrated a loculated 11x9cm pseudocyst that extended caudally from the posterior gastric wall to the transverse mesocolon. A third CT scan obtained two months later showed no change in the dimensions of the pseudocyst. At that time the patient opted for laparoscopic enteric drainage of her pseudocyst concomitant with a cholecystectomy.
The cystgastrostomy was performed first. An anterior gastrostomy was made parallel to the greater curve of the stomach. A laparoscopic needle was used to aspirate pancreatic fluid through the posterior gastric wall in the region of the pseudocyst. Once the cyst location was confirmed, the ultrasonic shears were used to create a cystgastrostomy. As pancreatic fluid and necrotic pancreatic debris were aspirated from the cyst, the bulge in the transverse mesocolon collapsed. An endoscopic stapler with 2.5mm loads was used to enlarge the cystgastrostomy. The anterior gastrostomy was closed with a 3.5mm stapler load.
A cholecystectomy with intra-operative cholangiogram was performed next. The patient tolerated the procedure well and had an uncomplicated post-operative course.
Laparoscopic cystgastrostomy can be performed safely and with low morbidity.