Background: Laparoscopic treatment of pancreatic pseudocyst allows for definitive drainage with
faster recovery. Although many groups have reported their experience with an anterior approach,
only a few have done so with a posterior approach. This paper compares the approaches, analyzing
their potential benefits and pitfalls.
Materials and Methods: Seven females and one male underwent laparoscopic cystgastrostomy to
treat pancreatic pseudocysts. The anterior approach was performed by opening the stomach anteriorly,
localizing the pseudocyst ultrasonographically, draining the cyst with a needle and, via the
same opening, using a stapler to form a cystgastrostomy. The posterior approach was performed
by directly visualizing the posterior gastric wall and the pseudocyst, opening and draining the cyst
with a needle, and using a stapler and running sutures for closure.
Results: All patients had gallstone pancreatitis. Cystgastrostomy via the anterior approach was
used in 4 patients and via the posterior approach in 4 patients. Dense adhesions required one attempted
posterior cystgastrostomy to be converted to an anterior approach. The mean age of the
anterior group was 38 years (range, 18–58 years) and hospital stay was 6 days (range, 4–8 days):
for the posterior group, mean age was 42 years (range, 40–44 years) and length of stay was 3 days
(range, 2–4 days).
Conclusion: Although both approaches had good results with no complications and short hospital
stays, the posterior approach is safer, with a more precise cyst visualization and dissection that
permits more tissue to be sent for histopathologic examination. Furthermore, the posterior approach’s
larger anastomosis would seem to yield fewer occlusions, which are commonly seen with
the anterior approach. The anterior approach is easier to learn, but it requires the opening of the
anterior stomach and the use of ultrasound.
