2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
176 http://www.sages.org/
P191–Hepatobiliary/Pancreatic
Surgery
MINIMALLY INVASIVE INCISION FOR CYSTGASTROSTOMY IN
LARGE PANCREATIC PSEUDOCYSTS, S Dissanaike MD, B
Barragan MD,J A Griswold DO,E E Frezza MD, Texas Tech
University Health Sciences Center
There are many approaches to the treatment of pancreatic
pseudocysts, including laparoscopic, endoscopic and open
surgical drainage. We have previously described the merits of
the posterior approach to laparoscopic cystgastrostomy (LCG).
We describe a minimally invasive approach to open drainage
in patients with very large pseudocysts and compare this to
our previous experience with both laparoscopic and open cystgastrostomy.
METHODS
Seven patients underwent LCG, two patients underwent open
CG via standard incision and two patients underwent open CG
(OCG) with a small (less than 10cm) left subcostal incision. The
laparoscopic group consisted of both anterior and posterior
approaches. The open group consisted of those with a midline
incision. The minimally invasive open group had a left subcostal
incision placed approximately 3-4 cm below the costal
margin for direct approach to the pseudocyst.
RESULTS
All of the patients developed pancreatitis and pseudocyst secondary
to gallstones. Three patients had LCG via the anterior
approach; four via the posterior approach. Two patients had
OCG via the midline incision, and two via the smaller subcostal
incision.
The open group had larger pseudocysts (21 +/- 3cm diameter)
than the laparoscopic group (10 +/- 3cm). Most of the patients
in the open group also had previous major abdominal operations
(n=3).The combination of large cysts and previous operations
made these patients less suitable for the LCG approach
and at a higher risk of conversion. The patients with the minimal
subcostal incision had pseudocysts of 22 and 24 cm,
respectively. The post-operative analgesic requirements, time
to return of bowel function and length of stay was shorter in
the laparoscopic (4 +/- 2 days) and minimally invasive open
groups (5 +/- 2 days), compared to the midline approach (10
+/- 2 days).
CONCLUSION
We have previously reported that LCG is usually associated
with less post-operative pain and quicker return to function
than the open operation. However, patients with a very large
pseudocyst may not be suitable candidates for safe LCG. In
these patients, we found that we were able to successfully perform
an OCG using a minimal subcostal incision. This enabled
an earlier return to function and less post-operative pain when
compared to the open midline approach, with a mean hospital
stay similar to patients with LCG.
P192–Hepatobiliary/Pancreatic
Surgery
LAPAROSCOPIC　PANCREATIC CYSTGASTOROSTOMY,
Kazunori Furuta PhD, Hiroki Hoshino MD,Masamichi Katori
PhD,Kouichi Itabashi PhD,Tsuyoshi Takahashi PhD,Muneki
Yoshida PhD,Masahiko Watanabe PhD, Kitasato University
Internal drainage of acute pancreatic pseudocysts is indicated
that have no reduced 8 weeks after the first occurrence of
pseudocysts.
Pancreatic pseudocysts are best drainage by pseudocystgastrostomy,
when they are located in adhere closely with the
posterior wall of the stomach. Pseudocystgastrostomy can be
completed using of intraorgan surgical technique.We present
the case of laparoscopic pancreatic cystgastrostomy.
Using a technique of percutaneous endoscopic gastrostomy,
under gastroendoscopic observation, three intragastric ports
are placed through the abdominal walls and the anterior gastric
walls.
One port for a telescope and the other two ports for bi-hand
instruments are established.
After the location of the pseudocysts is confirmed, the posterior
gastric wall and cyst wall can be incised and drainage orifice
is made by electrocautery and Harmonic Scalpel (Ethicon
Endo-Surgery). After a sufficient orifice is made, the cyst contents
are discharged into the stomach completely. After the
intragastric ports are removed, the defect of the anterior gastric
walls are closed with sutures in laparoscopically.This
approach is less invasive than the conventional procedure and
a safe procedure for cyst drainage. However, in the treatment
for pancreatic pseudocysts, there are many options that convention
surgery, catheter drainage of cysts , using interventional
radiology technique and endoscopic interventions.
Laparoscopic pancreatic cystgastrostomy is one of the treatment
options.
?@This procedure should be the one of the method of choice
when the interventional methods are not effective.
P193–Hepatobiliary/Pancreatic
Surgery
QUALITY OF LIFE AFTER LAPAROSCOPIC AND OPEN CHOLE-
CYSTECTOMY-A COMPUTER BASED ANALYSIS USING THE
GASTROINTESTINAL QALITY OF LIFE (GIQLI ) INDEX, Istvan
Gal PhD, Lorand Nagy, Department of Univ.Teaching Surgery
Bugat Pal Hospital, Gyöngyös Hungary
Qality of life is a multifactorial construction of several dimensions:
emotional or psychological well being, physical function,
social relations and symptoms of diseases as well as
results of treatment. For assesment of these dimensions tha
Gastrointestinal Qality of Life Index (GIQLI) developed by
Eypasch et al. was used. The GIQLI is a questionnaire containing
36 questions each with five response categories. These
data were analysed with a computer program ( SPSS for
Windows)
Inthe present study the GIQLI was tested in 240 patients who
were randomised for laparoscopic (LC)-120pts- or open (OC)-
120 pts- cholecystectomy. The obtained data were compared
to data of healthy volunteers ( 168). The questionnaires were
filled by the operated patients under the control of a physician
at the follow-up visits at 1 to 5 years after surgery.
There was significant ( p less 0.05) difference between the
mean score of the LC group( 115,00 plus- minus 18,98 GIQLI
points) and that of the patients underwent OC ( 108 plus-minus
22.48 GIQLI points). The mean value of healthy volunters
group ( 124, 8 plus-minus 13 GIQLI points) was not significantly
higher than that LC group , while it was significantly higher (
p less 0.01) than that of the OC group. The mean values measured
at different time points following the operations ( within 1
year 107.65 OC vs. 112.94 LC, in the 5th year 111.76 OC vs
119.39 LC) were similar, and they did not show signifivant differences
( p less 0.05) comparing the starting values.
In cinclusion, the quality of life can be a measurable parameter
for the clinical practice. The computer program SPSS for
Windows seems to be usefol for statistical analysis of quality
of life data. The GIQLI scores demonstrated that quality of life
following LC does not differ significantly from that of healthy
volunteers, while after the OC a significantly poorer quality of
life was registered.
P194–Hepatobiliary/Pancreatic
Surgery
ENDOSCOPIC ULTRASOUND EVALUATION DIRECTS LAPARO-
SCOPIC RESECTION OF PANCREATIC NEOPLASMS, T C
Gamblin MD, N Jani MD,K McGrath MD,K K Lee MD, Divisions
of Surgical Oncology and Gastroenterology, Hepatology, and
Nutrition, University of Pittsburgh, Pittsburgh, PA., USA
Introduction: Although laparoscopic resection of the distal
pancreas is technically feasible and safe, its oncologic appropriateness
for the treatment of invasive pancreatic cancer
remains undetermined. Endoscopic ultrasound (EUS) provides
detailed imaging of pancreatic abnormalities and can guide
fine needle aspiration (FNA) of these abnormalities. We
describe in two patients the use of EUS with FNA to establish
the low malignant potential of solid pancreatic masses and
their subsequent treatment by means of laparoscopic distal
pancreatectomy.
Methods/Procedures: Two patients were found on abdominal
CT to have solitary solid masses in the body of the pancreas.
EUS demonstrated the masses to be hypoechoic with well-