The retrogastric transventricular approach for drainage of the "supragastric" pancreatic pseudocyst

The majority of pancreatic pseudocysts develop in a retrogastric situation and are amenable to transgastric cystogastrostomy through the anterior gastric wall. We have encountered two pseudocysts in an unusual situation, in which adherence of the anterior gastric wall to the anterior parietal peritoneum precluded this approach. A retrogastric exposure through the lesser sac allowed for the creation of a cystogastrostomy through the superior aspects of the anterior and posterior gastric walls, adjacent to the lesser curvature of the stomach. This type of drainage is successful despite the theoretical failure to satisfy the dictum of dependent drainage.