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Background: A technique combining upper endoscopy with percutaneous transgastric minilaparoscopic instrumentation for the formation of pancreatic cystgastrostomy is safe and effective for the internal drainage of pancreatic pseudocysts., Methods: At a tertiary-care academic medical center, 6 patients with pancreatic pseudocysts with a mean size of 19 cm (range, 16-23 cm) were selected for combined endoscopic and percutaneous transgastric minilaparoscopic (1.7-2 mm) pancreatic cystgastrostomy. All pseudocysts had been followed-up for a minimum of 5 weeks (range, 5-22 wk) and were noted to significantly displace the stomach anteriorly., Results: The mean surgical time was 98 minutes (range, 45-150 min). The mean amount of fluid removed from the pseudocysts was 2167 mL (range, 1600-2600 mL). All ports were removed from the stomach without the need to suture the gastric wall or skin except for 2 gastric serosal sites that were closed with a single intracorporeal stitch. The length of hospital stay averaged 2.2 days (range, 0-6 d). All patients were discharged in good condition, tolerating a regular diet. With a mean follow-up period of 13.4 months (range, 1-30 mo), all patients remain asymptomatic from their pancreatic pseudocysts., Conclusions: The technique of combining upper endoscopy with percutaneous transgastric minilaparoscopic instruments to create a pancreatic cystgastrostomy can be used to apply well-established surgical principals for internal drainage and has the potential to be used for the management of other gastric pathology.

Gastroesophageal reflux disease (GERD) is one of the most common pathologies treated by primary care physicians. Despite advances in antacid pharmacological treatments, many patients remain refractory to maximal medical therapy. In addition, many others are either unable to tolerate the side effects of the drugs or simply are unwilling to receive life-long daily medications. Laparoscopic Nissen fundoplication has evolved as the surgical procedure of choice for patients with GERD. Although the durability of surgical management has been questioned, experienced surgeons achieve long-term reflux cure rates of about 85% to 95%. Barrett's esophagus has recently been considered an additional indication for surgical therapy of reflux due to evidence of dysplasia regression following a 360 degrees fundoplication. However, the timing of surgical intervention and the exact procedure for patients with both short- and long-segment Barrett's esophagus remains debatable. Esophageal dysmotility in surgical patients with GERD has traditionally been approached by "tailoring" the degree of fundoplication. Recent evidence suggests that partial fundoplication may not be effective and that full fundoplication should still be employed. The degree of dysmotility prohibitive to a full 360 degrees fundoplication remains controversial and should be addressed with future randomized trials. Finally, patients with failed fundoplication represent a formidable diagnostic dilemma and a technical challenge. In experienced hands, these patients can still benefit from minimally-invasive restorative or "re-do" fundoplications with minimal perioperative morbidity and good long-term results.