Pancreatic Pseudocyst - Drainage
- Prep nipples to pubic symphysis.
- Place the patient in the supine position.
- Upper midline incision (bilateral subcostal/transverse abdominal should also be considered).
- Exposure of lesser sac through gastrocolic or gastrosplenic ligaments.
- Possible Kocher maneuver for head/uncinate involvement.
- Anticipate adhesions from prior pancreatitis.
- Avoid extensive dissection, particularly healthy pancreas.
- Determine number, location, and size of pseudocyst(s).
- Use intraoperative ultrasound to evaluate cyst contents and relationship with major vessels.
- Identify possible targets for cystoenterostomy.
- Cystogastrostomy or Roux-en-Y Cystojejunostomy