Laparoscopic Transgastric versus Endoscopic Drainage of a Large Pancreatic Pseudocyst. A Case Report.

BACKGROUND Pancreatic pseudocysts are the most common complication of acute and chronic pancreatitis. They account for 75% of the cystic lesions of the pancreas. CASE REPORT A 37 year-old woman was admitted three months after an episode of severe acute pancreatitis with a large tumor mass located in her left abdomen, abdominal tenderness and asthenia. Abdominal Computed Tomography (CT) revealed a giant pancreatic pseudocyst of 23/15/12 centimeters. We performed an anterior laparoscopic transgastric cystogastrostomy. The postoperative clinical course was uneventful, and she was discharged nine days later. After another month she was re-admitted for general malaise and fever. We performed endoscopic evaluation of the cystogastrostomy patency followed by lavage of the pseudocyst cavity. After five days of broad spectrum antibiotic therapy the clinical course started to improve and the patient was discharged after another eight days. One- and two-year follow-ups revealed no remnant cavity. CONCLUSIONS Laparoscopic transgastric cystogastrostomy is a feasible option for selected patients with pancreatic pseudocysts. Careful patients' evaluation in a multidisciplinary team, including imaging specialists, dedicated gastroenterologists with experience in advanced interventional techniques and pancreatic surgeons, balancing between watchful waiting and step-up minimally invasive approach offers the best tailored approach for a specific patient.