Step

The jejunum is transected with a mechanical stapler 20 cm from the ligament of Treitz.

The distal end is oversewn and brought up to the cyst as a Roux limb.

3-0 interrupted silk sutures are placed between the cyst wall and midway between the antimesenteric and mesenteric borders of the posterior jejunal wall for 4-5cm or longer and tied down after all sutures are placed (A-1).

A cystotomy is made in similar fashion as for cystogastrostomy and cystoduodenos-tomy; a biopsy is taken of the cyst wall (A-2).

An interrupted single layer of 3-0 silk sutures is placed between the cyst and the jejunum to create an anterior wall (A-3).

The cystojejunostomy is completed as for side-to-side cystoduodenostomy (A-4).

Cystoduodenostomy
A-3

STEP 3

The proximal jejunum is anastomosed to the Roux limb 60 cm distally.

Jejunal Cystostomy

STEP 4

When the pseudocyst does not bulge through the mesocolon and is not adherent to the stomach or duodenum, the gastrocolic ligament is taken down to enter the lesser sac. The Roux limb is brought retrocolic either to the right or left of the mesocolic vessels. The anastomosis of the pseudocyst is done as in Step 2.

Pancreatic Pseudocyst Cystojejunostomy

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