Megan Berger1, Melena D Bellin2, Varvara Kirchner1, Sarah Jane Schwarzenberg3, Srinath Chinnakotla4. 1. Department of Surgery, University of Minnesota Masonic Children's Hospital, Minneapolis, MN. 2. Department of Surgery, University of Minnesota Masonic Children's Hospital, Minneapolis, MN; Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN. 3. Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN. 4. Department of Surgery, University of Minnesota Masonic Children's Hospital, Minneapolis, MN; Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN. Electronic address: chinni@umn.edu.
Abstract
BACKGROUND: Total Pancreatectomy and Islet Autotransplantation (TPIAT) are a potential treatment for children with severe, refractory chronic pancreatitis. A laparoscopic-assisted approach provides a smaller incision and excellent visualization of the distal pancreas and spleen during resection. A minimally-invasive approach has proven advantageous for other pediatric procedures, but its value is unknown for this rare operation. This retrospective review compares outcomes between patients undergoing laparoscopic-assisted versus open TPIAT. STUDY DESIGN: Children (n = 21) receiving laparoscopic-assisted TPIAT from 2013 to 2015 and children (n = 21) receiving open TPIAT from 2011 to 2015 were matched based on age, gender, symptom duration, previous interventions, and pancreatic fibrosis scores. Data reviewed included postoperative complications, operative time, estimated blood loss (EBL), intraoperative blood transfusions, number of islet equivalents (IEQ)/kg transplanted, hospital length-of-stay, graft function, narcotic use, and Patient Scar Assessment Questionnaire scores. Between-group differences were compared using Fisher's exact, Chi-square, and T-tests. RESULTS: Surgical complications were similar between surgical groups (p = 0.35) and included wound complications (n = 11), chyle leak (n = 7), bowel obstruction (n = 5), bile leak (n = 3), gastrointestinal bleed (n = 2), and pneumonia (n = 1). There were no significant differences in operative time (p = 0.18), EBL (p = 0.96), blood transfusions (p = 0.34), IEQ/kg transplanted (p = 0.15), and hospital length-of-stay (p = 0.66). Insulin and opioid use was similar except for a slightly higher use of opioids (n = 4) at 2 years in the laparoscopic group. Patient surgical scar satisfaction was similar between groups (p = 0.26). CONCLUSIONS: Outcomes for laparoscopic-assisted TPIAT appear comparable to open TPIAT. In children, a minimally-invasive approach does not compromise safety, effectiveness, or operative efficiency and may be used based on surgeon and patient preference.
BACKGROUND: Total Pancreatectomy and Islet Autotransplantation (TPIAT) are a potential treatment for children with severe, refractory chronic pancreatitis. A laparoscopic-assisted approach provides a smaller incision and excellent visualization of the distal pancreas and spleen during resection. A minimally-invasive approach has proven advantageous for other pediatric procedures, but its value is unknown for this rare operation. This retrospective review compares outcomes between patients undergoing laparoscopic-assisted versus open TPIAT. STUDY DESIGN:Children (n = 21) receiving laparoscopic-assisted TPIAT from 2013 to 2015 and children (n = 21) receiving open TPIAT from 2011 to 2015 were matched based on age, gender, symptom duration, previous interventions, and pancreatic fibrosis scores. Data reviewed included postoperative complications, operative time, estimated blood loss (EBL), intraoperative blood transfusions, number of islet equivalents (IEQ)/kg transplanted, hospital length-of-stay, graft function, narcotic use, and Patient Scar Assessment Questionnaire scores. Between-group differences were compared using Fisher's exact, Chi-square, and T-tests. RESULTS: Surgical complications were similar between surgical groups (p = 0.35) and included wound complications (n = 11), chyle leak (n = 7), bowel obstruction (n = 5), bile leak (n = 3), gastrointestinal bleed (n = 2), and pneumonia (n = 1). There were no significant differences in operative time (p = 0.18), EBL (p = 0.96), blood transfusions (p = 0.34), IEQ/kg transplanted (p = 0.15), and hospital length-of-stay (p = 0.66). Insulin and opioid use was similar except for a slightly higher use of opioids (n = 4) at 2 years in the laparoscopic group. Patient surgical scar satisfaction was similar between groups (p = 0.26). CONCLUSIONS: Outcomes for laparoscopic-assisted TPIAT appear comparable to open TPIAT. In children, a minimally-invasive approach does not compromise safety, effectiveness, or operative efficiency and may be used based on surgeon and patient preference.
Authors: Jaimie D Nathan; Yi Yang; Anne Eaton; Piotr Witkowski; Martin Wijkstrom; Matthew Walsh; Guru Trikudanathan; Vikesh K Singh; Sarah J Schwarzenberg; Timothy L Pruett; Andrew Posselt; Bashoo Naziruddin; Sri Prakash Mokshagundam; Katherine Morgan; Luis F Lara; Varvara Kirchner; Jin He; Timothy B Gardner; Martin L Freeman; Kate Ellery; Darwin L Conwell; Srinath Chinnakotla; Gregory J Beilman; Syed Ahmad; Maisam Abu-El-Haija; James S Hodges; Melena D Bellin Journal: Pancreatology Date: 2021-09-29 Impact factor: 3.996
Authors: Robert W Cowan; Erica D Pratt; Jin Muk Kang; Jun Zhao; Joshua J Wilhelm; Muhamad Abdulla; Edmund M Qiao; Luke P Brennan; Peter J Ulintz; Melena D Bellin; Andrew D Rhim Journal: Clin Transl Gastroenterol Date: 2021-11-18 Impact factor: 4.488