CHAPTER 10 Transgastric cystgastrostomy
Step 1. Surgical anatomy
♦ Preoperative imaging, typically an abdominal computed tomography scan, is imperative to determine the location of the pancreatic pseudocyst relative to the stomach. For the transgastric approach, the cyst needs to be directly posterior to the stomach.
♦ Attention should be paid to the location of the splenic artery, to make certain that it is not at risk for injury when creating the cystgastrostomy.
♦ If the cyst is not directly posterior to the stomach, an alternative approach is necessary. A cystojejunostomy is ideal in such cases and can often be performed laparoscopically.
Step 2. Preoperative considerations
Patient preparation
♦ The diagnosis of pancreatic pseudocyst should be firmly established. The patient typically has a history of pancreatitis, but further investigation is necessary to confirm the diagnosis.
♦ Preoperative evaluation includes a computed tomography scan to determine the size and location of the cyst, as well as an endoscopic retrograde cholangiopancreatogram (ERCP) to assess for communication between the pancreatic duct and the cyst.
♦ In some instances, endoscopic ultrasound or aspiration of the cyst for amylase and lipase levels may be warranted. Pancreatic pseudocysts typically have high levels of amylase and lipase.
♦ Once the diagnosis of pseudocyst is made, the cyst wall should be allowed to mature for at least 6 weeks prior to surgical drainage.
Step 3. Operative steps
Percutaneous endoscopic gastrostomy tube placement
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
