Virinder Kumar Bansal, Om Prakash, Asuri Krishna, Subodh Kumar, Shardool V Gupta, Aditya Baksi, M. C. Misra, Pramod Garg. AIIMS, New Delhi
Introduction: Surgical drainage remains the cornerstone for management of symptomatic pseudocyst/ walled off necrosis of pancreas. With advancement in laparoscopic technique, laparoscopic cystogastrostomy has been attempted increasingly. We present our experience of laparoscopic cystogastrostomy at a tertiary referral centre.
Material and Method: This is a retrospective analysis of 134 patients with pseudocyst of pancreas operated in a single surgical unit between July 2005 and July 2018. Under general anaesthesia, anterior wall of stomach was opened around 3-4 cm with Harmonic scalpel. A 12-mm bariatric port was inserted into pseudocystthrough common posterior stomach and cyst wall. Cyst cavity was aspirated and irrigated with normal saline. A wide cystogastrostomy was made with endostapler and the anterior gastrotomy was closed in two layers by intracorporeal suturing. The parameters like operative time, conversion to open,post-operative complications, hospital stay were noted and resolution of the cyst was documented at regular follow up.
Results: Out of 134 patients, 129 patients (96.3%) underwent laparoscopic cystogastrostomy and 5 patients (3.7%) laparoscopic loop cystojejunostomy.Twelve patients (9.0%) were converted to open for various reasons (dense adhesion between stomach and parietal wall n=6, collapse and rupture of cyst wall n=3, intraoperative bleeding n=3). Cause of pancreatitis was alcohol induced in 34 (25.4%),biliary in 53(39.6%), idiopathic in 40 (29.9%) and others in 7(5.2%) patients.Concomitant cholecystectomy was performed in 49 patients with biliary pancreatitis. Mean operative time was 97 minutes (64 to 144 minutes). In 2 patients (1.5%) open re-exploration was done for post-operative upper gastrointestinal bleed. Three patients (2.2%) had port site infection while 4 patients had bile leak. Mean hospital stay was 4.47 days (2 -19 days). Eight of 12 patients who were readmitted with fever underwent endoscopic lavage while 4 patients were managed conservatively. At follow up of 12 months, resolution of cyst was achieved in 95.5% (n=128) which was confirmed by ultrasonography. Recurrence was managed by endoscopic cystogastrostomy in 3 patients while 3 patientsdid not require any intervention.
Conclusion: Laparoscopic cystogastostomy gives excellent result with a very high cyst resolution and minimal complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94368
Program Number: S153
Presentation Session: MIS Medley
Presentation Type: Podium