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Published on: June 17, 2018
Laparoscopic treatment of pancreatic pseudocysts in children
Suzanne M Yoder1, Steven Rothenberg, Kuojen Tsao
1Department of Pediatric Surgery, Rocky Mountain Hospital for Children, Denver, Colorado 80218, USA. suzyoder@yahoo.com
Insights
Laparoscopic cystgastrostomy is a safe and effective minimally invasive treatment for pediatric pancreatic pseudocysts. This approach offers rapid recovery and high success rates, making it a suitable first-line option for children.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastroenterology
Background:
- Pancreatic pseudocysts are complications of pancreatitis or trauma, causing pain and obstruction.
- Pediatric management of pseudocysts with minimally invasive techniques is under-documented.
- This study reviews laparoscopic cystogastrostomy in children.
Purpose of the Study:
- To illustrate technical variations in laparoscopic cystogastrostomy for pediatric pancreatic pseudocysts.
- To assess the safety and efficacy of this minimally invasive approach in children.
Main Methods:
- Retrospective review of 13 pediatric patients undergoing laparoscopic cystogastrostomy across five institutions.
- Analysis of patient data, operative techniques, and postoperative outcomes.
Main Results:
- Mean patient age was 10.4 years; common etiologies included trauma, gallstones, and idiopathic.
- Laparoscopic cystogastrostomy was achieved with varied techniques (transgastric, intragastric ports, staplers, sutures).
- 92% of patients had complete resolution with minimal morbidity and rapid recovery.
Conclusions:
- Laparoscopic cystogastrostomy is a safe and effective first-line treatment for pediatric pancreatic pseudocysts.
- Varied techniques can achieve high success rates and rapid recovery.
- This minimally invasive approach should be considered for children with chronic pseudocysts.
Background:
Pancreatic pseudocysts are problematic sequelae of pancreatitis or pancreatic trauma causing persistent abdominal pain, nausea, and gastric outlet obstruction. Due to the low volume of disease in children, there is scant information in the literature on the operative management of pseudocysts with minimally invasive techniques. We conducted a multi-institutional review to illustrate several technical variations utilized in achieving laparoscopic cystgastrostomy in the pediatric population.
Methods:
A retrospective review was conducted of all patients who underwent laparoscopic cystgastrostomy in five institutions. Patient data, operative techniques, and postoperative course were analyzed.
Results:
There were 13 patients with a mean age of 10.4 years and mean weight of 52.1 kg. The etiologies of pancreatitis included: trauma (4), gallstones (3), chemotherapy (2), hereditary (1), and idiopathic (3). Preoperative radiographic measurements of the maximal cyst diameter averaged 11.7 cm. Cystgastrostomy was approached by using transgastric exposure in 5 cases and intragastric ports in 8 cases. An average of four ports were used to complete these operations. Mean operative time was 113 minutes. There were no conversions in this series. Cystgastrostomy was performed by using an endoscopic stapler (average 3.8 loads) in 6 cases, sutures in 6 cases, and 1 was formed solely with the Harmonic Scalpel (Johnson and Johnson). Gastrotomy sites were closed by using a stapler in 4 cases and suture techniques in 9. Mean time to initial and goal feeds was 3 and 4 days, respectively. Postoperative imaging revealed persistent pseudocyst in 1 patient, who was treated with a distal pancreatectomy. Therefore, 92% required no further operative intervention and remained asymptomatic upon recovery from their pancreatitis.
Conclusion:
A laparoscopic approach to pancreatic cystgastrostomy for chronic pseudocyst proved to be safe and effective in this five-institution survey. Techniques varied, but 92% had complete resolution with minimal morbidity and rapid recovery. Laparoscopic cystgastrostomy should be considered as an appropriate first-line treatment for chronic pseudocysts in children.