Laparoscopic pancreatic resection.

The extent of reported laparoscopic resections vary from enucleation to pancreaticoduodenectomy. Although initial series have been reported with encouraging results, most patients with pancreatic disease requiring resection are still treated with an open approach. We present a review of our experience and of the world literature on laparoscopic pancreatic resection. Laparoscopic pancreaticoduodenectomy has been attempted in 12 patients with a conversion rate of 33%. Complications occurred in the laparoscopic group. The laparoscopic patients have experienced no benefit in the postoperative recovery and convalescence. Early experience with the hand-assisted approach is promising. Sixty-eight laparoscopic distal pancreatectomies and enucleations have been reported to date. They were 42 distal pancreatectomies and 26 enucleations. Thirteen procedures have been converted to open surgery (19.1%). There was no mortality and the main postoperative complication was pancreatic leak (5 patients, 7.3%). Average hospital stay was 9 days. These results compare favorably with the outcomes after open pancreatic resection. While laparoscopic pancreaticoduodenectomy is not associated with patient benefit and may be accompanied by increased morbidity, laparoscopic distal pancreatectomy and enucleation are safe, carry low morbidity and have encouraging results in terms of postoperative recovery.