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Pseudocyst Pancreas

Laparoscopic drainage is an effective minimally invasive approach for managing pancreatic pseudocysts. Pancreatic pseudocysts are amylase-rich fluid collections that develop due to pancreatic inflammation or injury. They may cause symptoms or complications when large, increasing in size, or pressing on nearby organs. Laparoscopic drainage techniques include cystogastrostomy, cystoduodenostomy, cystjejunostomy, and can be used to treat pseudocysts in various locations when they are greater than 6 cm, rapidly enlarging, symptomatic, or complicated. The procedure involves placing ports and performing an internal drainage procedure between the cyst and stomach or intestine under direct visualization to drain the cyst contents. Comp

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Shashidhara Puttaraj
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3K views17 pages

Pseudocyst Pancreas

Laparoscopic drainage is an effective minimally invasive approach for managing pancreatic pseudocysts. Pancreatic pseudocysts are amylase-rich fluid collections that develop due to pancreatic inflammation or injury. They may cause symptoms or complications when large, increasing in size, or pressing on nearby organs. Laparoscopic drainage techniques include cystogastrostomy, cystoduodenostomy, cystjejunostomy, and can be used to treat pseudocysts in various locations when they are greater than 6 cm, rapidly enlarging, symptomatic, or complicated. The procedure involves placing ports and performing an internal drainage procedure between the cyst and stomach or intestine under direct visualization to drain the cyst contents. Comp

Uploaded by

Shashidhara Puttaraj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Laparoscopic Management of

Pseudocyst Pancreas
Introduction
• Pancreatic pseudocyst is a collection of
amylase-rich pancreatic juice enclosed by a wall
of fibrous granulation tissue related to an
antecedent episode of pancreatic inflammation
• Pancreatic pseudocyst (PP) accounts for over
75% of the cystic lesions of the pancreas.
• These cysts are treated by percutaneous,
endoscopic or surgical approaches

Bradley EL, 3rd, (1993) A clinically based classification system for acute pancreatitis. Summary
of the International Symposium on Acute Pancreatitis, Atlanta, Ga,Arch Surg 128: 586-90.
Differential Diagnosis

• Cystic neoplasms of pancreas


• True pancreatic cysts
-unilocular cyst
-enterogenous cyst
-retention cyst
• Parasitic cysts (echinococcal cyst)
• Extrapancreatic cysts
– duplication cyst
– mesenteric cyst
– splenic cyst
– adrenal cysts
Indications
• Symptomatic cysts
• Rapidly enlarging cysts
• Cyst diameter more than 6cm
• Complications
– rupture
– infection
– obstruction adjacent organs.
Relative Contraindications

• Recurrent cysts following open surgery


• Multiple cysts
• Multiple prior surgeries
Factors determining the route &
time of intervention

• Location of the cyst


• Maturity of the cyst wall
• Presence or absence of complications
• Availability of the local expertise
& experience.

Bhattacharya D Ammori BJ, (2003) Minimally invasive approaches to the management of pancreatic
pseudocysts: review of the literature. Surg Laparosc Endosc Percutan Tech 13: 141-8.
Pancreatic pseudocysts
• Percutaneous techniques
– Percutaneous aspiration-drainage
• Endoscopic techniques
– Endoscopic transgastric drainage
– Endoscopic transpapillary procedures
• Surgical Techniques
– External drainage
– Internal drainage
– Excision
– Newer alternative : Laparoscopic approach
Internal drainage Types
• Cystogastrostomy
– Pseudocyst adherent to posterior wall of the
stomach,
• Cystoduodenostomy
– Pseudocysts in the head and uncinate process of
pancreas.
• Cystjejunostomy
– Cysts in all other locations.
• Distal pancreatic resection or ductal
decompression
– Stricture of the duct
Transpapillary drainage
• Clear communication
• Advantages
– No close proximity
– Wall thickness irrelevant
– No entrotomies
• 84 – 93 % successful
Patient position
Port position
Lap Transgastric
Cystogastrostomy
Lap Transgastric
Cystogastrostomy
Lap Cystjejunostomy
Lap Transgastric
Cystogastrostomy
Complications

• Infection
• Prolonged drainage
• Bowel obstruction
• Hemorrhage
• Recurrence
• Residual cyst needing intervention
Laparoscopic drainage - Our experience

• 108 Patients
– Lap Cystgastrostomy - 90
– Lap Cystjejunostomy - 08
– Open Cystgastrostomy - 02
– Lap External Drainage - 08

Surg Endosc. 2007 Dec;21(12):2262-7. Epub 2007 May 22

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