A bilateral subcostal incision is preferred; alternatively, a midline incision may be used.
After routine abdominal exploration, a mechanical ring retractor is placed to retract the liver and abdominal wall.
The pseudocyst adherent to the posterior gastric wall is visualized or palpated transgastrically.
Seromuscular stay sutures are placed in the anterior gastric wall over the cyst.
A long gastrotomy is made, and the anterior gastric wall is retracted using stay sutures.
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