The lesser sac (omental bursa) is the peritoneal compartment posterior to the stomach and lesser omentum, communicating with the greater sac via the epiploic foramen. It is the space targeted in drainage of lesser sac fluid collections — pancreatic pseudocyst, walled-off necrosis, and gastric perforation collections.
The lesser sac space is accessed endoscopically via the posterior stomach wall (transgastric drainage) for pancreatic pseudocyst and walled-off necrosis. Laparoscopic lesser sac entry through the gastrocolic omentum is the standard approach for distal pancreatectomy and splenic surgery. The lesser sac cystogastrostomy creates a permanent communication between the pseudocyst and the stomach for drainage.
Pancreatic fluid collection walled off in the lesser sac following acute pancreatitis, producing epigastric fullness and early satiety, drained endoscopically via transgastric access or laparoscopically through the gastrocolic omentum.
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