Video: Laparoscopic Anterior Cystogastrostomy

This video, Supplemental Digital Content 1, http://links.lww.com/SLE/A10, shows the steps necessary to carry out a stapled laparoscopic cystogastrostomy through an anterior gastrotomy. As with open surgery, at least a 3-cm anastamosis should be created to reduce the risk of early closure and recurrent pseudocyst formation. Although the initial minimally invasive cystogastrostomies reported were carried out by placing the laparoscopic trocars directly into the stomach, the anterior approach uses only 1 gastrostomy procedure and may have a decreased risk of gastric leak. A posterior approach has been described here; however, it may be more technically demanding. Only when the pseudocyst does not clearly communicate with the posterior stomach wall should cystojejunostomy be attempted. This can be done with a loop of jejunum or through a Roux-en Y.