Vol. 65, No. 5, May 2015 565 Abstract Laparoscopic Pancreatic Pseudocyst (PP) surgery can be performed via anterior or posterior cystogastrostomy, endoscopy-assisted surgery and cystojejunostomy. We conducted a prospective analysis of our patients undergoing laparoscopic cystogastrostomy to analyse the merits and demerits of the procedure. In a period of 3 years from January 2010 to December 2012 all the patients who underwent laparoscopic drainage of pancreatic pseudocysts were prospectively analysed. A total of 12 patients underwent a transgastric anterior cystogastrostomy with a stoma size of 4.5cms. There was no intraoperative or postoperative bleeding or leakage on anastomotic lines. Post-op pain score on the first post-op day was 4 (2-5) on the Visual Analogue Scale (VAS). Average hospital stay was 4.1±2.3 days. All patients had complete resolution of symptoms on follow-up. Follow- up computed tomography (CT) scans on 8 patients showed complete resolution of the cysts. Laparoscopic cystogastrostomy is a safe and feasible method and provides efficient drainage of PP. Keywords: Laparoscopic Pancreatic Pseudocyst, Cystogastrostomy. Introduction Pancreatic pseudocyst (PP) is defined as a collection of pancreatic juice, enclosed by a wall of fibrous or granulation tissue, which arises as a consequence of acute pancreatitis, pancreatic trauma or chronic pancreatitis. 1 The documented incidence of pseudocyst following acute pancreatitis has increased with the availability of ultrasound and computed tomography (CT). Adherence to current definitions is important for valid interpretation and comparison, as the majority of pancreatic fluid collections in acute pancreatitis will regress spontaneously 2 and do not progress to pseudocyst formation. The incidence of pseudocyst formation following acute pancreatitis ranges from 12% to 55% in different series. 3-5 About 75% of all pancreatic masses are pancreatic pseudocysts. 1,2 A PP takes about 4-6 weeks for the wall to mature and most of them resolve by 6 weeks. 1-3 Asymptomatic patients are managed conservatively by observation and radiological follow-up using serial ultrasonography or CT scans. Although the indication and timing of the intervention in PP related to acute pancreatitis are still controversial, but there is an agreement that large, persistent and symptomatic cysts should be drained since they are usually associated with complications. The internal drainage of PP, which is the method of choice, can be achieved by surgical or endoscopic interventions. Endoscopic therapy is a promising modality, but requires experienced endoscopist and might be associated with stent-related complications, inadequate drainage, repeated interventions and risk of perforation 6 which may require emergency surgery. Surgery continues to be the chief method in PP drainage. Laparoscopic PP surgery is minimally invasive, provides detailed information about PP location and the relationship with adjacent organs, and enables effective drainage. Laparoscopic cystogastrostomy was first performed by J. Petelin 7 in 1994. The morbidity is low, PP wall biopsy is achievable and cholecystectomy can be added to the procedure in the presence of biliary pancreatitis. Numerous techniques have been reported for laparoscopic PP surgery thus far, including anterior and posterior cystogastrostomies, endoscopy-assisted surgery and cystojejunostomy. 8 Initial results indicate a success rate of 77-100%, with a complication rate of 8-17% and no mortality or recurrence. 9-11 Total reported numbers are small and larger series are required for meaningful comparison with other treatment modalities, open surgery in particular. We present our experience in the laparoscopic PP management. The current study was planned to analyse the merits and demerits of laparoscopic PP management at tertiary care public and private sector hospitals. Subjects and Methods The prospective interventional study was conducted from January 2010 to December 2012 at the Services Institute of Medical Sciences, Lahore, and the National Hospital and Medical Centre, Lahore. CASE SERIES Laparoscopic cystgastrostomy: A Pakistani perspective Awais Amjad Malik, 1 Hafiz Ghulam Isnain, 2 Ahsan Khan, 3 Asad Ali Toor, 4 Allah Nawaz, 5 Rashid Mansoor, 6 Romaisa Shamim, 7 Mahmood Ayyaz 8 1,2,5-8 Services Institute of Medical Sciences, 3,4 National Hospital & Medical Centre, Lahore. Correspondence: Awais Amjad Malik. Email: awaisamjad@gmail.com