General Surgery

Pancreatic Pseudocyst Drainage (Cystgastrostomy)

OPERATION: Cystgastrostomy — Internal Drainage of Pancreatic Pseudocyst
ANAESTHETIC: General anaesthesia
POSITION: Supine

INDICATION:
Symptomatic pancreatic pseudocyst [> 6 cm / persistent / enlarging]. Location: [body / tail — posterior to stomach]. Cyst wall maturation confirmed [> 6 weeks post-pancreatitis]. [EUS-guided drainage not available / failed / preferred surgical approach].

INCISION: Upper midline.

PROCEDURE:
WHO Checklist performed. Abdomen explored. Pseudocyst identified bulging through the posterior gastric wall. Stomach opened via anterior gastrotomy. Posterior gastric wall adherent to anterior cyst wall palpated and confirmed.

Needle aspiration of pseudocyst through posterior gastric wall to confirm position and decompress. Fluid sent for amylase, cytology, and MC+S.

Wide opening created through the posterior gastric wall into the pseudocyst using diathermy [size approximately 3–4 cm]. Cyst contents evacuated and sent for analysis. Cyst cavity inspected and debrided if required. [Biopsy of cyst wall taken for histology].

Cystgastrostomy anastomosis secured with continuous absorbable haemostatic sutures to the edges of the opening in the posterior gastric wall / cyst wall, ensuring wide-bore drainage maintained.

Anterior gastrotomy closed in two layers with absorbable suture. Haemostasis confirmed.

FINDINGS:
Pseudocyst [size, contents — clear / turbid / infected]. Cyst wall [mature and thick]. No evidence of malignancy.

SPECIMEN: Cyst fluid and wall to histopathology and microbiology.
EBL: [Volume] ml. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Oral fluids when bowel sounds return. Serum amylase monitored. CT abdomen [6–8 weeks] to confirm cyst resolution. Outpatient review.