PANCREAS > Laparoscopic Roux-en-y Cystojejunostomy

Patient and Port position: Patient placed in modified Lloyd Davies position.

Pneumoperitoneum is created by veress needle through 10 mm Supraumbilical skin incision which is later on converted into 10mm camera port.10mm port – RUQ and LUQ, 5mm- port at epigastric, left anterior axillary and right hypochondrium areas are placed.

STEPS:
After initial general assessment of peritoneal cavity lesser sac is opened by dividing gastrocolic ligament. Retrogastric adhesions separated Posterior wall of stomach dissected from pseudocyst wall. Cavity localized by aspirating fluid from anterior surface of body of pancreas. Pseudocyst opened by harmonic transversely and fluid and necrotic material evacuated. Roux limb prepared 15cm distal to DJ flexure by endo GIA (white stapler). 60cm alimentary limb prepared and alimentary limb anastomosed to biliopancraetic limb by endo GIA stapler (white).  Enterotomy closed by 3-0 PDS sutures. Alimentary limb taken up in supracolic compartment antecolically and cystojejunostomy done by continuous PDS 3-0 sutures.

Since it was gall stone induced pancreatitis cholecystectomy was also completed.