S Velmurugan, HOD of GI and Lap Surgery, R Villalan, B Kasi Viswanath, R Archana. kauvery hospital, Trichy, India
62 years female presented with left upper quadrant pain, back pain and postprandial fullness of 4 months duration. She had past medical history of Diabetes and Hypertension. Her abdominal examination was unremarkable. Her CT scan showed a 6 cm sized cystic lesion in the tail of pancreas close to splenic hilum. There was no associated lymphadenopathy. In addition, the CT showed a 2.5 cm sized adenoma in left adrenal gland.
She had an EUS guided FNAC from the cystic lesion. It was suggestive of mucinous lesion. Her endocrine work up showed that the adrenal adenoma was a non secreting lesion.
After informed consent, laparoscopic distal pancreatectomy with splenectomy and left adrenalectomy was performed.
Surgical procedure : One 10-12 mm port , one 10 mm port and two 5 mm ports used. Gastrocolic omentum divided with harmonic and lesser sac entered. Short gastric vessels divided. Inferior and superior border of pancreas defined. Retro- pancreatic tunnel created at distal body of pancreas medial to the lesion. As splenic vessels were going through the lesion, proceeded for splenectomy en bloc. Splenic artery and splenic vein ligated and clipped (hemolock) individually and divided. Pancreas divided with stapler using green cartridge at distal body leaving adequate margin from the lesion. Distal pancreatectomy with splenectomy done. Left adrenal identified and dissected. Left adrenal vein clipped and divided. Left adrenalectomy done. Stapled pancreatic end underrun with 2-0 PDS continuous suture. Drain kept. Specimen retrieved using a bag through pfannensteil incision.
Post operatively she had an uneventful recovery. She was discharged on the 6th post operative day. Her histology confirmed mucinous cystadenoma arising from the tail of pancreas and the adrenal lesion was a non functioning adenoma.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95903
Program Number: V379
Presentation Session: Video Loop Day 4
Presentation Type: VideoLoop
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