Many techniques have been described to treat large pancreatic pseudocysts including simple aspiration, endoscopic drainage, and cyst-gastrostomy. The cyst-jejunostomy can be performed using a loop of jejunum, however fewer surgeons are performing laparoscopic Roux-en-Y cystjejunostomies given its increased complexity. We demonstrate a case of a large pseudocyst managed with laparoscopic Roux-en-Y cystjejunostomy.

In the past, a 56 year old male with a history of pancreatitis and both a distal pancreatic mass and a 3cm nonfunctioning left adrenal mass had undergone a robotic-assisted distal pancreatectomy and splenectomy and an attempted left adrenalectomy. Significant bleeding during that operation led to a conversion to an open technique. The final pathology showed a pancreas adenoma, but no adrenal tissue was found.

Two years later, the patient presented to our office complaining of 3 months of an increasing sensation of abdominal pressure and bloating with early satiety. Work-up included an abdominal CT scan which showed a 20cm x 15cm pseudocyst, as well as the adrenal mass that was unchanged in size from two years prior. We therefore decided to continue to observe the adrenal mass. However, for management of the pseudocyst we elected to perform a laparoscopic Roux-en-Y cystjejunostomy using a combined linear stapler / hand-sewn anastomoses. The patient had an uneventful post-operative recovery. Cyst contents were sent to pathology and found to be benign. At follow-up, a CT scan shows the collapsed pseudocyst.

Laparoscopic Roux-en-Y cystjejunostomy is a feasible alternative to manage large pancreatic pseudocysts, and it maintains optimal long term cyst drainage. Use of a Roux limb as opposed to a loop cystjejunostomy limits the incidence of post operative cyst reaccumulation and prevents passage of afferent luminal contents into the cyst cavity.