Laparoscopic management of pancreatic pseudocyst
Chowbey, P.K.; Dewan, A.; Khullar, R.; Sharma, A.; Soni, V.; Baijal, M.; Vashishtha, A. and Dhir, A. (2002) Laparoscopic management of pancreatic pseudocyst. In: 5th Annual Conference of Indian Association of Gastrointestinal Endo-surgeons (IAGES), 31st Jan - 3rd Feb 2002, Kolkatta, India.
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Rapid advances in surgical expertise, instrumentation and video endoscopic anatomy of peritoneal cavity have occurred over past decade. The growing experience has widened the horizon of procedures to be successfully performed laparoscopically. Surgical management of pancreatic pseudocyst comprises dependent drainage into an appropriate bowel lumen. Several reports are now available describing laparoscopic management of pancreatic pseudocyst. This is the commonest benign cyst affecting the pancreas. Over the past 2 years, this procedure has been performed on eight patients. Six patients developed the psuedocyst after acute alcoholic pancreatitis and two following acute biliary pancreatitis. The diameter of the pseudocyst ranged from 8-12 cm. The procedure was performed using five ports. The Harmonic Scalpel was used to create two ports in the anterior stomach wall through which two self retaining were placed into the gastric lumen. The trocars were used to lift up the anterior gastric wall. This created the space for the cystogastrostomy to be fashioned laparoscopically through the balloon trocar. The ball probe of the Harmonic Scalpel was used to puncture the cyst through the posterior gastric I wall. The cystogastrostomy was completed by firing an Endo-GIA 30 stapler across the fused posterior gastric wall and anterior I wall of the cyst. Laparoscopic cystogastrostomy offers a feasible and safe therapeutic option for selected patients with large symptomatic pancreatic pseudocysts.
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