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Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre

Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre
Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre
Background: Laparoscopic pancreatic surgery has been slow to gain wide acceptance due to the complex pancreatic anatomy and physiology. The aim of this study was to analyze our preliminary results and highlight the impact of centralization on surgeon workload and pancreatic surgical innovation.

Methods: A retrospective analysis was performed on all patients who underwent laparoscopic distal pancreatectomy from May 2007 to October 2008.

Results: Laparoscopic distal pancreatectomy was performed in 17 patients during that period. Median operative time was 180 min (range 120–300 min). Median blood loss was 100 ml (range 50–500 ml). Splenectomy was performed in 12 patients. None of the patients was converted to open operation. All patients were kept in high-dependency unit for median duration of 1 day (range 0–1 day). One patient with previous cardiac disease was kept in intensive therapy unit for one night, but discharged home on 7th postoperative day without any complications. Postoperative recovery was uneventful in 13 patients, while four patients had pancreatic leak. One pancreatic leak was observed in the last 11 patients, in which pancreatic stump was oversewn. In three patients, pancreatic leaks (PL) were minor and settled with conservative management, while one patient needed a computed tomography (CT)-guided drainage and subsequent minilaparotomy for wash out of the intra abdominal collection. None of the patients died in this series. Median hospital stay was 5 days (range 4–7 days).

Conclusions: Laparoscopic distal pancreatic resection is feasible, safe, and efficient. However, this surgery should only be performed in specialized centres with extensive experience in pancreatic and laparoscopic surgery. Oversewing the pancreatic stump after transaction with Endostapler may reduce the incidence of pancreatic leak. Centralization of pancreatic surgery has a positive impact on building up surgical expertise, resulting in obvious benefits for both patients and institutions.
0930-2794
2743-2747
Abu Hilal, Mohammed
384e1c60-8519-4eed-8e92-91775aad4c47
Jain, Gaurav
480918b2-3227-446a-b1f4-53a17e948c3f
Kasasbeh, Farhan
c1aee615-d520-4faf-80ee-3f2299a3994f
Zuccaro, Massimiliano
1cddd0c1-3eff-4c64-8ffe-c453c4622863
Elberm, Hassan
179e1b44-cd08-4853-8479-c73d7b3a3608
Abu Hilal, Mohammed
384e1c60-8519-4eed-8e92-91775aad4c47
Jain, Gaurav
480918b2-3227-446a-b1f4-53a17e948c3f
Kasasbeh, Farhan
c1aee615-d520-4faf-80ee-3f2299a3994f
Zuccaro, Massimiliano
1cddd0c1-3eff-4c64-8ffe-c453c4622863
Elberm, Hassan
179e1b44-cd08-4853-8479-c73d7b3a3608

Abu Hilal, Mohammed, Jain, Gaurav, Kasasbeh, Farhan, Zuccaro, Massimiliano and Elberm, Hassan (2009) Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre. Surgical Endoscopy, 23 (12), 2743-2747. (doi:10.1007/s00464-009-0499-y). (PMID:19462202)

Record type: Article

Abstract

Background: Laparoscopic pancreatic surgery has been slow to gain wide acceptance due to the complex pancreatic anatomy and physiology. The aim of this study was to analyze our preliminary results and highlight the impact of centralization on surgeon workload and pancreatic surgical innovation.

Methods: A retrospective analysis was performed on all patients who underwent laparoscopic distal pancreatectomy from May 2007 to October 2008.

Results: Laparoscopic distal pancreatectomy was performed in 17 patients during that period. Median operative time was 180 min (range 120–300 min). Median blood loss was 100 ml (range 50–500 ml). Splenectomy was performed in 12 patients. None of the patients was converted to open operation. All patients were kept in high-dependency unit for median duration of 1 day (range 0–1 day). One patient with previous cardiac disease was kept in intensive therapy unit for one night, but discharged home on 7th postoperative day without any complications. Postoperative recovery was uneventful in 13 patients, while four patients had pancreatic leak. One pancreatic leak was observed in the last 11 patients, in which pancreatic stump was oversewn. In three patients, pancreatic leaks (PL) were minor and settled with conservative management, while one patient needed a computed tomography (CT)-guided drainage and subsequent minilaparotomy for wash out of the intra abdominal collection. None of the patients died in this series. Median hospital stay was 5 days (range 4–7 days).

Conclusions: Laparoscopic distal pancreatic resection is feasible, safe, and efficient. However, this surgery should only be performed in specialized centres with extensive experience in pancreatic and laparoscopic surgery. Oversewing the pancreatic stump after transaction with Endostapler may reduce the incidence of pancreatic leak. Centralization of pancreatic surgery has a positive impact on building up surgical expertise, resulting in obvious benefits for both patients and institutions.

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Published date: 22 May 2009

Identifiers

Local EPrints ID: 172185
URI: http://eprints.soton.ac.uk/id/eprint/172185
ISSN: 0930-2794
PURE UUID: 7553740c-ae6c-4576-a4de-48c766a9c97a

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Date deposited: 24 Jan 2011 14:31
Last modified: 14 Mar 2024 02:28

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Contributors

Author: Mohammed Abu Hilal
Author: Gaurav Jain
Author: Farhan Kasasbeh
Author: Massimiliano Zuccaro
Author: Hassan Elberm

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