cystogastrostomy

Cystogastrostomy is a surgical procedure designed to create a direct communication between a pancreatic pseudocyst and the stomach, allowing internal drainage of cyst contents into the gastric lumen. The operation is most commonly used for pancreatic pseudocysts that are in close contact with the stomach wall and are large or symptomatic.

Indications include symptomatic pancreatic pseudocysts, large size, persistent drainage failure after several weeks, infection, rupture, or gastric or biliary obstruction by the cyst. Cysts that are well-adherent to the stomach wall are particularly amenable to cystogastrostomy because they allow safe creation of a durable drainage tract.

Techniques range from open cystogastrostomy to laparoscopic cystogastrostomy, both aiming to connect the posterior stomach wall to the cyst cavity with a stable stoma, followed by drainage of cyst contents into the stomach. Endoscopic cystogastrostomy, performed under endoscopic ultrasound guidance with transmural access and stent placement, is a less invasive option in selected patients and may be considered a related approach in appropriate settings.

Outcomes are generally favorable, with resolution of the pseudocyst in a majority of cases and relief of symptoms. Recurrence is less likely when a durable internal drainage tract is created. Complications include bleeding, infection, injury to adjacent organs, leakage or fistula formation, and, for endoscopic approaches, stent-related issues such as migration or occlusion.

Postoperative management involves gradual reintroduction of diet, imaging to confirm cyst drainage, and monitoring for complications. Follow-up focuses on recurrence surveillance and nutritional status.