Cystogastrostomy
Cystogastrostomy
Indications
Symptomatic pancreatic pseudocysts are an indication a cystogastrostomy needs to be performed. Pancreatic pseudocysts are chronic collections of pancreatic fluid encased by a wall of nonepithelialized granulation tissue and fibrosis. They can be caused by leakage of the pancreatic duct, or as a result of inflammatory pancreatitis. Symptoms of this include abdominal bloating, difficulty eating and digesting food, and constant pain or deep ache in the abdomen. A lump can be felt in the middle or left upper abdomen if a pseudocyst is present. To further diagnose a pancreatic pseudocyst an abdominal CT scan, MRI or ultrasound can be used. Emergency surgery may need to be performed if there is a rupture of the pseudocyst. This can be detected from symptoms of bleeding, shock, fainting, fever and chills, rapid heartbeat, or severe abdominal pain.
Technique
Surgical cystogastrostomy
Surgical repair is carried out through an incision in the abdomen. After locating the pseudocyst, it is attached to the wall of the stomach and the cystogastrostomy is created. Although it has a high success rate, it is infrequently used because of the recovery period.
Endoscopic cystogastrostomy
A relatively new and less-invasive method involving endoscopic ultrasound (EUS) guidance and fluoroscopy. A large bore needle is used to access the identified pseudocyst, creating a fistula between the cystic cavity and either the stomach or the duodenum. Plastic stents may be placed to facilitate drainage from the pseudocyst. The success rate of endoscopic treatment of pseudocysts may be greater than 70%.
Laparoscopic cystogastrostomy
This method is the second of two less invasive surgeries used to drain pseudocysts and can be performed by a single surgeon because of the advanced tools. The pseudocyst is identified and accessed using laparoscopic techniques. Once the pseudocyst cavity is located, it is entered and aspirated, and an opening is created into the stomach for drainage. Laparoscopic drainage may result in better cosmetic appearance and decreased pain following surgery.
How to Prepare for a Cystogastrostomy
You should not eat or drink anything after midnight prior to the procedure. Your doctor will let you know if or when you should adjust or stop any medications you take. Because you will be sedated, you will need someone to drive you home after the procedure.