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Minimally Invasive Open Cystogastrostomy for Giant Pancreatic Pseudocyst in Pediatric Patients
Rahul Gupta1, Ratendra Singh1, Anu Bhandari2
1Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.
Insights
This study presents a minimally invasive open cystogastrostomy technique for pediatric pancreatic pseudocysts. The approach proved safe and effective, offering a viable surgical option with good patient outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Procedures
Background:
- Pancreatic pseudocysts are a common complication requiring surgical intervention.
- Open cystogastrostomy is the standard surgical management for pancreatic pseudocysts.
- Giant pediatric pancreatic pseudocysts present unique surgical challenges.
Purpose of the Study:
- To describe and evaluate a minimally invasive open cystogastrostomy technique for giant pediatric pancreatic pseudocysts.
- To assess the safety and efficacy of this novel approach in pediatric patients.
Main Methods:
- Ultrasound-guided incision marking on the pseudocyst.
- Minilaparotomy with a 3-4 cm transverse incision.
- Exteriorization of the anterior stomach wall for gastrotomy and cystogastrostomy.
- Use of stay sutures and Deaver's retractor for precise procedure execution.
Main Results:
- The technique was successfully applied in five male pediatric patients.
- No intraoperative or postoperative complications were reported.
- Patients were discharged after a mean of 7 days post-operation.
- Scar size ranged from 3 to 5 cm, indicating minimal scarring.
Conclusions:
- Minimally invasive open cystogastrostomy is a safe and effective treatment for pediatric pancreatic pseudocysts.
- This technique offers a viable alternative to traditional open surgery, with good cosmetic and clinical outcomes.
Abstract:
Open cystogastrostomy is the standard treatment for the operative management of pancreatic pseudocysts. We describe our technique of minimally invasive open cystogastrostomy for giant pediatric pancreatic pseudocyst. Preoperative incision marking on the most prominent part of the pseudocyst was done by ultrasound guidance. A transverse incision of approximately 3-4 cm was made, and a minilaparotomy was performed. Stay sutures were applied on the anterior wall of the stomach. The anterior wall was exteriorized; transverse gastrotomy was performed, and superior and inferior flaps were made. Deaver's retractor was placed inside the lumen, and cystogastrostomy was completed. We employed this technique in five male patients without any complications. All patients were allowed clear liquids on postoperative day 4 or 5; and gradually shifted to a soft diet. The mean duration of postoperative stay was 7 days. The size of the scar ranged from 3 to 5 cm. All patients were doing well on follow-up. Our technique of minimally invasive open cystogastrostomy is a viable option for pancreatic pseudocyst in pediatric patients.
