Minh Dao Quang, Truc Vu Trung et al Hanoi Department of Health THANH NHAN HOSPITAL LAPAROSCOPIC CYSTOGASTROSTOMY FOR THE TREATMENT OF PANCREATIC PSEUDOCYSTS: A CASE REPORT Minh Dao Quang, Truc Vu Trung et al Hai Phong, November 2017

Introduction Pancreatic pseudocyst: Treatment: 85% after acute or chronic pancreatitis 15% after abdominal trauma Treatment: Internal drainage Percutaneous drainage Endoscopic drainage Thanh Nhan hospital presents the case of laparoscopic cystogastrostomy for treatment of pancreatic pseudocyst. Dẫn lưu ngoài, dẫn lưu trong, dẫn lưu nội soi: tùy vào vị trí của nang giả tụy (giữa dạ dày và đại tràng; sau dạ dày; giữa mạc nối gan và dạ dày; u nang đuôi tụy; u nang trên mạc treo đại tràng)

Decribe case study Male 44 years old History: Alcoholism; Cirrhosis Child B Acute pancreatitis Reason for hospitalization: abdominal mass grow up in 2 months Feeling the mass on the epigastric region with 10x15cm, less mobil, pressing pain Ultra sound, Ctscanner: showed a pancreatic pseudocyst of 10x15cm located in the body of the pancreas.

CTscanner CT-scanner: showed a pancreatic pseudocyst of 10x15cm located in the body of the pancreas.

Surgical steps General anesthesia with endotracheal intubation Reverse trendelenburg position, tilt to the right Marker the surgical region and trocar position

Look over abdominal cavity: ascites (+) Surgical steps Look over abdominal cavity: ascites (+)

Surgical steps Look over abdominal cavity: Cyst is seen bulging from behind the stomach.

Surgical steps Laparoscopic view of posterior wall of stomach after anterior gastrostomy. Cyst is seen bulging from behind the stomach.

Percutaneous aspiration of cyst to locate position. Surgical steps Percutaneous aspiration of cyst to locate position.

Percutaneous aspiration of cyst to locate position. Surgical steps Percutaneous aspiration of cyst to locate position.

Surgical steps Extracorporeal suturing of cyst wall with posterior gastric wall use Linear cutting stapler 80-4.8mm with minimum open (4 cm)

Suturing the anterior wall of stomach Surgical steps Suturing the anterior wall of stomach

CTscanner postoperative Surgical steps CTscanner postoperative

Length of hospital stay Result of surgical Results Time Operation time 120 minutes Blood loss 20 ml Drug to less pain 48 hours Carminative actions Oral liquids 4 days Length of hospital stay 5 days

Discussion Muhammad SS. presented case study: Male patient 55 years old History: acute pancreatitis Feeling the mass on the epigastric region with 6x6cm 6 moths ago, posterior of stomach Laparoscopic cyst-gastrostomy was performed with 4 trocars; Percutaneous aspiration of cyst to locate position. Cyst wall and posterior gastric wall was then sutured together by continuous intracorporeal stitches using vicryl 2/0. Fully mobilized in 24 hours. Remove nasogastric tube 48 hours, oral liquids. 6 days in hospital Muhammad SS. (2009). Laparoscopic cyst-gastrostomy for pancreatic pseudocyst. Journal of the College of Physicians and Surgeons Pakistan 2009, Vol. 19 (8): 526-528

Discussion Muhammad SS. (2009). Laparoscopic cyst-gastrostomy for pancreatic pseudocyst. Journal of the College of Physicians and Surgeons Pakistan, Vol. 19 (8): 526-528

Discussion Palanivelu C. et al: 2007: 108 patients with 76M: 32F Duration of symptoms ranged from 45 days to 7 months Age ranged from 18 to 70 years Laparoscopic cystogastrostomy: 90 cases (83.4%), laparoscopic cystojejunostomy 8 cases (7.4%), open cystogastrostomy 2 cases (1.8%), laparoscopic external drainage 8 cases (7.4%) Operating time: 95 minutes Blood loss: 69 ml Re-operated for bleeding, gastric outlet obstruction: 1.8% Hospital stay: 5.6 days

Discussion Crisanto-Campos B.A. et al: 2012-2014: 17/38 laparoscopic surgery Size: 15.3cm (5.5-25cm) Operating time: 177 min (90-350 min) Blood loss: 151ml (20-300ml) Trocar bleeding : 1 patient (5.9%) Hospital stay: 6.8 days (2-18 days)

Conclusion Laparoscopic cystogastrostomy for treatment of pancreatic pseudocyst: Has a significant role to play in the surgical management of pseudocysts with excellent outcome. It offers all the benefits of minimally invasive surgery to the patients.

Thank you for attention!