Surgical Endoscopy

, Volume 30, Issue 3, pp 1235–1241 | Cite as

Laparoscopy-assisted open cystogastrostomy and pancreatic debridement for necrotizing pancreatitis (with video)

  • Olivier Gerin
  • Flavien Prevot
  • Abdennaceur Dhahri
  • Sami Hakim
  • Richard Delcenserie
  • Lionel Rebibo
  • Jean-Marc RegimbeauEmail author
Dynamic Manuscript



Pancreatic pseudocysts and walled-off necrosis are well-known complications, described in 10 % of cases of acute pancreatitis. Open cystogastrostomy is usually proposed after failure of minimally invasive drainage or in the presence of septic shock. The objective of this study was to evaluate the feasibility and efficacy of laparoscopy-assisted open cystogastrostomy for treatment of symptomatic pancreatic pseudocyst with pancreatic necrosis.

Materials and methods

Between January 2011 and October 2014, all patients with pseudocyst and pancreatic necrosis undergoing open cystogastrostomy were included. Surgical procedure was standardized. The primary efficacy endpoint was the feasibility and efficacy of laparoscopy-assisted open cystogastrostomy as treatment of symptomatic pancreatic pseudocyst. Secondary endpoints included demographic data, preoperative management, operative data, postoperative data and follow-up.


Laparoscopy-assisted open cystogastrostomy was performed in 11 patients [six men (54 %)], with a median age of 61 years (45–84). Nine patients received preoperative radiological or endoscopic management. First-line open cystogastrostomy was performed in two cases. Median operating time was 190 min (110–240). There was one intraoperative complication related to injury of a branch of the superior mesenteric vein. There were no postoperative deaths and two postoperative complications (18 %) including one major complication (postoperative bleeding). The median length of hospital stay after surgery was 16 days (7–35). The median follow-up was 10 months (2–45). One patient experienced recurrence during follow-up.


Open cystogastrostomy for necrotizing pancreatitis promotes adequate internal drainage with few postoperative complications and a short length of hospital stay. However, this technique must be performed very cautiously due to the risk of vascular injury which can be difficult to repair in the context of severe local inflammation related to pancreatic necrosis.


Pancreatic necrosis Pancreatic pseudocyst Open cystogastrostomy Laparoscopy-assisted 


Compliance with Ethical Standards


Olivier Gerin, Flavien Prevot, Abdennaceur Dhahri, Richard Delcenserie, Lionel Rebibo and Jean-Marc Regimbeau have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 23338 kb)

Supplementary material 2 (MPG 23258 kb)

Supplementary material 3 (MPG 24528 kb)

Supplementary material 4 (MPG 16104 kb)


  1. 1.
    Klöppel G (2000) Pseudocysts and other non-neoplastic cysts of the pancreas. Semin Diagn Pathol 17:7–15PubMedGoogle Scholar
  2. 2.
    Baron TH, Thaggard WG, Morgan DE, Stanley RJ (1996) Endoscopic therapy of organized pancreatic necrosis. Gastroenterology 111:755–764CrossRefPubMedGoogle Scholar
  3. 3.
    Bradley EL, Clements JL Jr, Gonzalez AC (1979) The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg 137:135–141CrossRefPubMedGoogle Scholar
  4. 4.
    O’Malley VP, Cannon JP, Postier RG (1985) Pancreatic pseudocysts: cause, therapy, and results. Am J Surg 150:680–682CrossRefPubMedGoogle Scholar
  5. 5.
    Gluck M, Ross A, Irani S, Lin O, Hauptmann E, Siegal J, Fotoohi M, Crane R, Robinson D, Kozarek RA (2010) Endoscopic and percutaneous drainage of symptomatic walled-off pancreatic necrosis reduces hospital stay and radiographic resources. Clin Gastroenterol Hepatol 8:1083–1088CrossRefPubMedGoogle Scholar
  6. 6.
    Regimbeau JM, Dupont H (2004) Should patients with acute severe pancreatitis be given antibiotic prophylaxis? Ann Chir 129:596–598CrossRefPubMedGoogle Scholar
  7. 7.
    Pitchumoni CS, Agarwal N (1999) Pancreatic pseudocysts. When and how should drainage be performed? Gastroenterol Clin North Am 28:615–639CrossRefPubMedGoogle Scholar
  8. 8.
    Itoi T, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Moriyasu F (2006) EUS-guided simultaneous internal and external drainage of pancreatic infected pseudocysts. Dig Endosc 18:71–74CrossRefGoogle Scholar
  9. 9.
    Will U, Wanzar C, Gerlach R, Meyer F (2011) Interventional ultrasound-guided procedures in pancreatic pseudocysts, abscesses and infected necroses—treatment algorithm in a large single-center study. Ultraschall Med 32:176–183CrossRefPubMedGoogle Scholar
  10. 10.
    Seifert H, Wehrmann T, Schmitt T, Zeuzem S, Caspary WF (2000) Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet 356:653–655CrossRefPubMedGoogle Scholar
  11. 11.
    Evans KA, Clark CW, Vogel SB, Behrns KE (2008) Surgical management of failed endoscopic treatment of pancreatic disease. J Gastrointest Surg 12:1924–1929CrossRefPubMedGoogle Scholar
  12. 12.
    Boutros C, Somasundar P, Espat NJ (2010) Open cystogastrostomy, retroperitoneal drainage, and G-J enteral tube for complex pancreatitis-associated pseudocyst: 19 patients with no recurrence. J Gastrointest Surg 14:1298–1303CrossRefPubMedGoogle Scholar
  13. 13.
    Bradley EL III (1993) A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg 128:586–590CrossRefPubMedGoogle Scholar
  14. 14.
    Connor S, Raraty MG, Howes N, Evans J, Ghaneh P, Sutton R, Neoptolemos JP (2005) Surgery in the treatment of acute pancreatitis-minimal access pancreatic necrosectomy. Scand J Surg. 94:135–142PubMedGoogle Scholar
  15. 15.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working Group (2013) Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 62:102–111CrossRefPubMedGoogle Scholar
  16. 16.
    Delany HM, Carnevale NJ, Garvey JW (1973) Jejunostomy by a needle catheter technique. Surgery 73:786–790PubMedGoogle Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Bourgeois M, Fumery M, Coron E, Giovannini M, Crinquette JF, Branche J, Antonietti M, Iwanicki-Caron I, Barange K, Yzet T, Brazier F, Bartoli E, Regimbeau JM, Dupas JL, Nguyen Khac E, Delcenserie R (2014) Su1709 Covered Self Expandable Metallic Stent (“Diabolo”) for the treatment of pancreatic fluid collections. Gastrointest Endosc 79(suppl):AB375CrossRefGoogle Scholar
  19. 19.
    Puli SR, Graumlich JF, Pamulaparthy SR, Kalva N (2014) Endoscopic transmural necrosectomy for walled-off pancreatic necrosis: a systematic review and meta-analysis. Can J Gastroenterol Hepatol 28:50–53PubMedCentralPubMedGoogle Scholar
  20. 20.
    Connor S, Alexakis N, Raraty MG, Ghaneh P, Evans J, Hughes M, Garvey CJ, Sutton R, Neoptolemos JP (2005) Early and late complications after pancreatic necrosectomy. Surgery 137:499–505CrossRefPubMedGoogle Scholar
  21. 21.
    Rau B, Bothe A, Beger HG (2005) Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series. Surgery 138:28–39CrossRefPubMedGoogle Scholar
  22. 22.
    van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG, Dutch Pancreatitis Study Group (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 362:1491–1502CrossRefPubMedGoogle Scholar
  23. 23.
    Kianmanesh R, Benjelloun M, Scaringi S, Leroy C, Jouet P, Castel B, Sabaté JM, Coffin B, Flamant Y, Msika S (2008) Fissure syndrome of a gastrointestinal artery pseudoaneurysm in contact with a pseudocyst of the pancreas: rare, but serious complication of chronic pancreatitis. Gastroenterol Clin Biol 32:69–73CrossRefPubMedGoogle Scholar
  24. 24.
    Martin RF, Hein AR (2013) Operative management of acute pancreatitis. Surg Clin North Am 93:595–610CrossRefPubMedGoogle Scholar
  25. 25.
    Varadarajulu S, Bang JY, Sutton BS, Trevino JM, Christein JD, Wilcox CM (2013) Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 145:583.e1–590.e1CrossRefGoogle Scholar
  26. 26.
    Simo KA, Niemeyer DJ, Swan RZ, Sindram D, Martinie JB, Iannitti DA (2014) Laparoscopic transgastric endolumenal cystogastrostomy and pancreatic debridement. Surg Endosc 28:1465–1472CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Olivier Gerin
    • 1
  • Flavien Prevot
    • 1
  • Abdennaceur Dhahri
    • 1
  • Sami Hakim
    • 2
  • Richard Delcenserie
    • 2
  • Lionel Rebibo
    • 1
  • Jean-Marc Regimbeau
    • 1
    • 3
    • 4
    Email author
  1. 1.Department of Digestive Surgery, Hôpital SudAmiens University HospitalAmiens Cedex 01France
  2. 2.Department of GastroenterologyAmiens University HospitalAmiens Cedex 01France
  3. 3.EA4294Jules Verne University of PicardieAmiens Cedex 01France
  4. 4.Clinical Research CenterAmiens University HospitalAmiens Cedex 01France

Personalised recommendations