P Senthilnathan, R Parthasarathi, S Rajapandian, P Praveen Raj, Anand Vijai, V P Nalankilli, G Srivatsan, Sandeep Sabnis, C Palanivelu. GEM Hospital & Research Centre
Introduction: Minimally invasive laparoscopic pancreatoduodenectomy is technically feasible and safe. An artery first approach to pancreatoduodenectomy is a critical technique to assess the complete oncological resection before an irreversible step is taken and to reduce the blood loss during the surgery. Artery first approach in laparoscopic pancreatoduodenectomy has an advantage in addition to that offered by minimally invasive surgery, the ability to assess the complete oncological clearance in the initial course of surgery. We share our experience of artery first approach in laparoscopic pancreatoduodenectomy.
Methods: Data of 9 patients undergoing elective laparoscopic pancreatoduodenectomy with one of the 3 artery first approaches (right posterior, medial uncinate, mesenteric) to SMA during January 2016 to July 2016 are retrospectively analyzed.
Results: Among 9 patients, carcinoma head of pancreas was seen in 3 cases, distal cholangiocarcinoma in 2 cases, duodenal adenocarcinoma in 2 cases, ampullary carcinoma in 1 case and neuroendocrine tumor of head of pancreas in 1 patient. 5 patients were males and 4 were females. Mean age of the patients was 61 (+/- 7.81) years. Mean duration of the surgery was 324.44(+/- 21.13) mins. Mean blood loss during the surgery was 214.4(+/-84.61) ml. All the cases were successfully completed by laparoscopic technique and no conversion was required. No intraoperative complications were seen. Average size of the tumor was 2.4 (+/-1.01) cm, average number of lymph nodes harvested during the surgery 14.6 (+/-8.26). Mean diameter of main pancreatic duct was 4 (+/- 1.66) mm, mean diameter of CBD was 12.4(+/- 4.28) mm. The mean postoperative hospital stay was 11.11(+/- 1.9) days. R0 resection was achieved in 8 cases. There was no mortality, however 1 patient developed delayed gastric emptying, 4 patients had Grade A pancreatic fistula, none of them developed Grade B or C pancreatic fistula and post pancreatoduodenectomy haemorrhage was seen in 1 patient. Post operative period of three patients was complicated by significant diarrhea requiring antidiarrheal medications.
Conclusion: Artery first approach in laparoscopic pancreatoduodenectomy is safe and feasible.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80844
Program Number: P466
Presentation Session: Poster (Non CME)
Presentation Type: Poster
