LAPAROSCOPIC CYSTO-GASTROSTOMY

     This is a laparoscopic surgical procedure done for the pseudocyst of pancreas. One of the common reasons for pseudocyst formation is biliary pancreatitis. Following biliary pancreatitis, there will be fluid collection around the pancreas which mature as a pseudocyst roughly after six weeks of biliary pancreatitis. This cyst usually presents with pain abdomen and sometime with mass over the epigastric region. But can present with fever in case of associated infection or with other associated symptoms which depends on the site and extend of pancreatic involvement and amount of fluid collection.

     The diagnosis is made by ultrasonography of abdomen and confirmed with computerised tomography with intravenous contrast. Usual position of the cyst is behind the stomach and the treatment offered is “Laparoscopic Cysto-gastrostomy”. Other available treatment options are open cysto-gastrostomy endoscopic cysto-gastrostomy and cysto-jejunostomy.

     In laparoscopic cysto-gastrostomy, the procedure is done under general anaesthesia. Usually, five ports are used on either side of the upper abdomen. After introducing laparoscope, cyst position is confirmed and other trocars are placed as per need. Anterior wall of stomach is opened in between stay sutures. Then the cyst position is confirmed with needle aspiration of the cyst. Once cyst is confirmed then posterior wall of stomach is opened with diathermy or harmonic scalpel. Then the cyst contents will be sucked out. The necrotic materials if present will also be removed (Necrosectomy). Thorough wash will be given. Laparoscopic examination of cyst will be done which will give better idea about the completeness of removal of pancreatic necrosis. After this, posterior wall of stomach and cyst wall will be sutured with absorbable sutures (Cysto-gastrostomy). Finally, anterior wall of stomach will be closed. Usually, a drainage tube will be placed and ports will be closed.

     The recovery will be smooth and patient can have liquid diet after two days. The magnified view of the laparoscopic technique gives better quality surgery along with better removal of necrosis if any.