Advertisement

Laparoscopic cystogastrostomy for the treatment of pancreatic pseudocysts in children

      Abstract

      Pancreatic pseudocysts (PPSs) are common sequelae of pancreatitis and pancreatic trauma. The management is based upon the pseudocyst size and presence of symptoms. Those requiring intervention are often drained using several available options. The use of laparoscopic cystogastrostomy for large and recurrent PPSs has been described in adult patients as a less morbid alternative to open drainage procedures. This technique is considered a novel approach in children.
      We describe 2 children who had PPSs amenable to laparoscopic cystogastrostomy. The first was an 11-year-old girl who had blunt abdominal trauma from a bicycle handlebar. The second patient was a 7-year-old girl who developed idiopathic pancreatitis. Briefly, 2 ports were placed through the anterior abdominal and gastric walls, and into the lumen of the stomach. This intraluminal placement provided access to the posterior gastric wall. Using electrocautery diathermy, an incision was made through the posterior gastric wall and into the adjacent pseudocyst to obtain complete and unobstructed drainage. Both children tolerated the procedures well with resolution of their PPSs. The patients were each discharged on the fourth postoperative day and have been asymptomatic on 2 years follow-up.
      Laparoscopic cystogastrostomy is a safe and effective alternative to open cystogastrostomy for the minimally invasive management of PPSs in the pediatric population.

      Index words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Falchetti D.U.M.
        • Torri F.
        • Salucci P.
        • et al.
        Endoscopic cure of pancreatic pseudocyst in a child.
        J Pediatr Gastroenterol Nutr. 1998; 27: 446-448
        • Ford E.G.
        • Harden J.
        • William D.
        • et al.
        Pseudocysts of the pancreas in children.
        Am Surg. 1990; 56: 384-387
        • Buntain W.L.
        • Wood J.B.
        • Woolley M.M.
        Pancreatitis in childhood.
        J Pediatr Surg. 1978; 13: 143-149
        • Stone H.H.W.J.
        Pseudocysts of the pancreas in children.
        Am J Surg. 1967; 114: 448-453
        • Grant J.P.
        • James S.
        • Grabowski S.
        • et al.
        Total parenteral nutrition in pancreatic disease.
        Ann Surg. 1984; 200: 627-631
        • Bass J.
        • S.B. D.M.
        • Desjardins J.G.
        • et al.
        Blunt pancreatic injuries in children: the role of percutaneous external drainage in the treatment of pancreatic pseudocysts.
        J Pediatr Surg. 1988; 23: 721-724
        • Beckingham I.
        • Krige J.
        • Bornman P.
        • et al.
        Endoscopic management of pancreatic pseudocysts.
        Br J Surg. 1997; 84: 1638-1645
        • Breckon V.
        • Thomson S.R.
        • Hadley G.P.
        Internal drainage of pancreatic pseudocysts in children using an endoscopically placed stent.
        Pediatr Surg Int. 2001; 17: 621-623
        • Burnweit C.
        • Wesson D.
        • Stringer D.
        • et al.
        Percutaneous drainage of traumatic pancreatic pseudocysts in children.
        J Trauma. 1990; 30: 1273-1277
        • Etzkorn K.P.
        • DeGuzman L.
        • Holderman W.
        • et al.
        Endoscopic drainage of pancreatic pseudocyst; patient selection and evaluation of outcome by endoscopic ultrasound.
        Endoscopy. 1995; 27: 329-333
        • Smits M.E.
        • Rauws E.A.J.
        • Tytgat G.N.J.
        • et al.
        The efficacy of endoscopic treatment of pancreatic pseudocysts.
        Gastrointest Endosc. 1995; 42: 202-207
        • Jaffe R.B.
        • Arata Jr., J.A.
        • Matlak M.E.
        Percutaneous drainage of traumatic pancreatic pseudocysts in children.
        AJR Am J Roentgenol. 1989; 152: 591-595
        • Rescorla F.J.
        • Cory D.
        • Vane D.W.
        • et al.
        Failure of percutaneous drainage in children with traumatic pancreatic pseudocyst in children.
        J Pediatr Surg. 1990; 25: 1038-1042
        • Karaguzel G.
        • Senocak M.E.
        • Buyukpamukcu N.
        • et al.
        Surgical management of the pancreatic pseudocyst in children: a long-term evaluation.
        J Pediatr Surg. 1995; 30: 777-780
        • Plancq M.C.
        • Villamizar J.
        • Ricard J.
        • et al.
        Management of pancreatic and duodenal injuries in pediatric patients.
        Pediatr Surg Int. 2000; 16: 35-39
        • Holeczy P.
        • Danis J.
        Laparoscopic transgastric pancreatic pseudocystogastrostomy—first experience with extraluminal approach.
        Hepatogastroenterology. 1998; 45: 2215-2218
        • Mori T.
        • Abe N.
        • Sugiyama M.
        • et al.
        Laparoscopic pancreatic cystogastrostomy.
        J Hepatobiliary Pancreat Surg. 2000; 7: 28-34
        • Mori T.
        • Abe N.
        • Sugiyama M.
        • et al.
        Laparoscopic pancreatic cystogastrostomy.
        J Hepatobiliary Pancreat Surg. 2002; 9: 548-554
        • Park A.
        • Schwartz R.
        • Tandan V.
        • et al.
        Laparoscopic pancreatic surgery.
        Am J Surg. 1999; 177: 158-163
        • Roth J.S.
        • Park A.E.
        Laparoscopic pancreatic cystogastrostomy.
        Surg Laparosc Endosc Percutan Tech. 2001; 11: 201-203
        • Siperstein A.
        Laparoendoscopic approach to pancreatic pseudocysts.
        Semin Laparosc Surg. 2001; 8: 218-222
        • Smadja C.
        • Badawy A.
        • Vons C.
        • et al.
        Laparoscopic cystogastrostomy for pancreatic pseudocyst is safe and effective.
        J Laparoendosc Adv Surg Tech A. 1999; 9: 401-403
        • Way L.
        • Legha P.
        • Mori T.
        Laparoscopic pancreatic cystogastrostomy: the first operation in a new field of intraluminal laparoscopic surgery.
        Surg Endosc. 1994; 8: 235-238
        • Benifla M.
        • Weizman Z.
        Acute pancreatitis in children.
        J Clin Gastroenterol. 2003; 37: 169-172
        • Cabrera R.
        • Otero H.
        • Blesa E.
        • et al.
        Pancreatic pseudocyst: review of 22 cases.
        Cir Pediatr. 1997; 10: 49-53
        • Lucaya J.
        • Vazquez E.
        • Caballero F.
        • et al.
        Non-operative management of traumatic pancreatic pseudocysts associated with pancreatic duct laceration in children.
        Pediatr Radiol. 1998; 28: 5-8
        • Schmittenbecher P.P.
        • Rapp P.
        • Dietz H.G.
        Traumatic and non-traumatic pancreatitis in pediatric surgery.
        Eur J Pediatr Surg. 1996; 6: 86-91
        • Ammori B.
        • Bhattacharya D.
        • Senapati P.
        Laparoscopic endogastric pseudocyst gastrostomy: a report of three cases.
        Surg Laparosc Endosc Percutan Tech. 2002; 12: 437-440
        • Chowbey P.K.
        • Soni V.
        • Sharma A.
        • et al.
        Laparoscopic intragastric stapled cystogastrostomy for pancreatic pseudocyst.
        J Laparoendosc Adv Surg Tech A. 2001; 11: 201-205
        • Frantzides C.
        • Ludwig K.
        • Redlich P.
        Laparoscopic management of a pancreatic pseudocyst.
        J Laparoendosc Surg. 1994; 4: 55-59
        • Van Heerden J.
        • Remine W.
        Pseudocysts of the pancreas: review of 71 cases.
        Arch Surg. 1975; 110: 500-505
        • Haluszka O.
        • Campbell A.
        • Horvath K.
        Endoscopic management of pancreatic pseudocyst in children.
        Gastrointest Endosc. 2002; 55: 128-131
        • Millar A.J.W.
        • Rode H.
        • Stunden R.J.
        • et al.
        Management of pancreatic pseudocysts in children.
        J Pediatr Surg. 1988; 23: 122-127
        • Patty I.
        • Kalaoui M.
        • Al-Shamali M.
        Endoscopic drainage for pancreatic pseudocyst in children.
        J Pediatr Surg. 2001; 36: 503-505
        • Windle R.
        • Finlay D.
        • Neoptolemos J.P.
        Needle aspiration in the treatment of pancreatic pseudocyst in childhood.
        Ann R Coll Surg Engl. 1983; 65: 331
        • Wales P.W.
        • Shuckett B.
        • Kim P.C.W.
        Long-term outcome after nonoperative management of complete traumatic pancreatic transection in children.
        J Pediatr Surg. 2001; 36: 823-827
        • Korman S.H.
        • Lebensart P.
        • Martin O.
        • et al.
        Pancreatic pseudocyst: successful treatment by percutaneous external catheter drainage.
        J Pediatr Gastroenterol Nutr. 1991; 12: 372-375
        • Bonnard A.
        • Lagausie P.
        • Malbezin S.
        • et al.
        Mediastinal pancreatic pseudocyst in a child.
        Surg Endosc. 2001; 15: 759