Chapter 38 Pancreatic Cyst/Debridement
Cystgastrostomy or Endoscopic Drainage
Roux-en-Y Cystjejunostomy
OPERATIVE PROCEDURE
Identification and Opening of the Pseudocyst Wall through the Transverse Mesocolon
Injury to the Mesocolon Vessels
• Repair
Oversewing of the bleeding vessel should control the bleeding. If it occurs from the pancreatic bed, oversewing of the vessel or topical coagulation should be attempted. If these maneuvers are not effective, packing of the cavity and immediate angiographic embolization of the bleeding vessel may be warranted.
• Prevention
Great caution should be used when creating the opening to perform this through an avascular plane in the mesocolon. Aspirating with a small-gauge needle may provide some safety before making the opening. One should avoid carrying the opening too medial to avoid injury to the middle colic vessels. Typically, the opening should be to the left of the ligament of Treitz to avoid this complication.
Creation of the Roux-en-Y Cystjejunostomy
Anastomotic Leak
• Repair
Percutaneous drainage of the fluid collection to try to create a controlled fistula is paramount. If the fluid is amylase rich, the patient should be started on octreotide. Once the drain has been left for 6 weeks, a drain study can be performed. If there is no collection, the drain can be removed and the epithelialized tract will generally seal.
External Drainage
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