1. 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

2. 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)

3. 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.

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

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

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

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

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

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

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

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

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

13. CTscanner postoperative
Surgical steps
CTscanner postoperative

14. 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

15. 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):

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

17. 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

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

19. 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.

20. Thank you for attention!