BACKGROUND AND AIMS: Laparoscopic distal pancreatectomy (LDP) is a safe alternative to conventional open distal pancreatectomy, with advantages that include smaller incisions, less pain, and shorter postoperative recovery. Despite these apparent advantages, however, uptake of the procedure has been slow, with only a handful of series published. MATERIAL AND METHODS: All LDPs performed in Brisbane, Australia, over a 10-year period (May 1996 to June 2006) were retrospectively reviewed. RESULTS: Forty-six consecutive LDPs were performed. A variety of lesions were resected, including nine cancers. Twelve patients were converted for oncological (6) or technical reasons (6). The spleen was retained in 14/29 patients, either by main splenic vessel preservation (9) or solely supported by the short gastric vessels (5), resulting in inferior pole infarction in 2 patients. Overall morbidity was 39%, including 15% pancreatic fistula. All fistulas resolved after a median of 6 weeks without re-operation. A non-significant trend toward fewer fistulas with stapled rather than sutured stump closure was observed (13% vs 19%; p=0.43). Median operative duration and hospital stay were 157 min and 7 days, respectively. There was no mortality. CONCLUSION: LDP is a safe alternative to conventional resection for a wide range of lesions. As with open resection, pancreatic fistula is the dominant morbidity, but is generally indolent. While spleen preservation is often possible, care must be taken to avoid infarction of the inferior pole if the Warshaw technique is utilized.
BACKGROUND AND AIMS: Laparoscopic distal pancreatectomy (LDP) is a safe alternative to conventional open distal pancreatectomy, with advantages that include smaller incisions, less pain, and shorter postoperative recovery. Despite these apparent advantages, however, uptake of the procedure has been slow, with only a handful of series published. MATERIAL AND METHODS: All LDPs performed in Brisbane, Australia, over a 10-year period (May 1996 to June 2006) were retrospectively reviewed. RESULTS: Forty-six consecutive LDPs were performed. A variety of lesions were resected, including nine cancers. Twelve patients were converted for oncological (6) or technical reasons (6). The spleen was retained in 14/29 patients, either by main splenic vessel preservation (9) or solely supported by the short gastric vessels (5), resulting in inferior pole infarction in 2 patients. Overall morbidity was 39%, including 15% pancreatic fistula. All fistulas resolved after a median of 6 weeks without re-operation. A non-significant trend toward fewer fistulas with stapled rather than sutured stump closure was observed (13% vs 19%; p=0.43). Median operative duration and hospital stay were 157 min and 7 days, respectively. There was no mortality. CONCLUSION: LDP is a safe alternative to conventional resection for a wide range of lesions. As with open resection, pancreatic fistula is the dominant morbidity, but is generally indolent. While spleen preservation is often possible, care must be taken to avoid infarction of the inferior pole if the Warshaw technique is utilized.
Authors: Jean-Yves Mabrut; Laureano Fernandez-Cruz; Juan Santiago Azagra; Claudio Bassi; Georges Delvaux; Joseph Weerts; Jean-Michel Fabre; Jean Boulez; Jacques Baulieux; Jean-Louis Peix; Jean-François Gigot Journal: Surgery Date: 2005-06 Impact factor: 3.982
Authors: J M Fabre; J L Dulucq; C Vacher; M C Lemoine; P Wintringer; D Nocca; J S Burgel; J Domergue Journal: Surg Endosc Date: 2002-05-03 Impact factor: 4.584
Authors: Jeff Root; Ninh Nguyen; Blanding Jones; Scott McCloud; John Lee; Phuong Nguyen; Ken Chang; Peter Lin; David Imagawa Journal: Am Surg Date: 2005-09 Impact factor: 0.688
Authors: Giuseppe R Nigri; Alan S Rosman; Niccolò Petrucciani; Alessandro Fancellu; Michele Pisano; Luigi Zorcolo; Giovanni Ramacciato; Marcovalerio Melis Journal: Surg Endosc Date: 2010-12-24 Impact factor: 4.584
Authors: S Rehman; S K P John; R Lochan; B C Jaques; D M Manas; R M Charnley; J J French; S A White Journal: World J Surg Date: 2014-02 Impact factor: 3.352
Authors: David J Worhunsky; Yulia Zak; Monica M Dua; George A Poultsides; Jeffrey A Norton; Brendan C Visser Journal: J Gastrointest Surg Date: 2014-06-18 Impact factor: 3.452