A Prospective Comparative Study of Hand-Sewn Versus Stapler Laparoscopic Cystogastrostomy in Management of Patients of Pseudocyst of Pancreas at A Tertiary Care Centre in Central India

Abstract

Introduction: A pancreatic pseudocyst is a localized collection of fluid rich in amylase, located within or adjacent to the pancreas and enclosed by a non-epithelial wall, which may develop as a consequence of pancreatic inflammation or injury. Pancreatic pseudocysts are the most common complication of acute or chronic pancreatitis. The first description of a pancreatic pseudocyst is attributed to Morgagni in 1761.Objectives: To compare various intra-operative parameters and post-operative outcomes in patients with pancreatic pseudo cyst undergoing Laparoscopic cysto gastrostomy either Hand sewn or Stapler use.Materials and methods: It's a prospective study in which all pancreatic pseudo cyst patients who underwent laparoscopic cysto gastrostomy with hand sewn and stapler (Green stapler 65mm) use at our institute were compared in terms of intra-operative parameters, duration of surgery and post-operative outcomes. Patients who managed by other interventions were excluded.Results: 12 patients in each group of hand sewn and of stapler used in LCG were enrolled. Stapled LCG was associated with significantly shorter operative time than hand sewn LCG. There was no significant post-operative pain and fever in both groups, no leak, no recurrence, no fistula in both groups. Both groups had shorter duration of postoperative hospital stay.Patients were followed up in OPD for 6 weeks. Cyst resolved in all patients.Endo GI stapler is costlier than Hand sewn method, and considering poor patients in our settings, stapler LCG was not cost effective.Conclusion: Stapler LCG was associated with significantly shorter operative time than hand sewn LCG. Use of stapler is costlier as compared to Hand sewn as the cost of stapler is more and considering poor patients in our settings, stapler LCG is not cost effective.