Pancreatic pseudocystgastrostomy with a peroral, flexible stapler: human natural orifice transluminal endoscopic surgery anastomoses in 2 patients (with videos)

Background

Complex, symptomatic pancreatic pseudocysts often must be surgically drained. Natural orifice surgery is an emerging field in which surgical procedures are performed by using an endoluminal approach through an existing body orifice.

Patients and Setting

Two patients at our institution, an academic, tertiary care center.

Design

Two patients who underwent a standard, stapled, surgical cystgastrostomy for drainage of a complex, infected pseudocyst by using a flexible stapling device are described. These procedures were performed under endoscopic observation and guidance, all transorally, without the need for laparotomy or laparoscopy.

Results

Both patients had a technically successful outcome, and both did well after surgery, with only mild chest pain and throat discomfort in one, and no adverse sequelae at all in the other patient. Both patients had complete resolution of their complex, debris-filled pseudocysts at 6 weeks when examined by endoscopy and at 3 months when examined by CT.

Conclusions

An entirely endoscopic, peroral, stapled pseudocystgastrostomy is feasible and can lead to an excellent outcome. For properly selected patients, this may be an alternative to more traditional types of surgical cystgastrostomy.

Abbreviations: ICU, intensive care unit, IRB, institutional review board, NOTES, natural orifice transluminal endoscopic surgery