INTRODUCTION: A laparoscopic approach to pancreatic disease is increasingly performed although its ultimate benefit is yet to be confirmed. Laparoscopic distal pancreatectomy with or without splenectomy is gradually gaining acceptance as an alternative to open resection in selected patients. The aim of this study is to report our initial institution experience with laparoscopic distal pancreatectomy in 17 patients.
METHODS: A retrospective review of database was carried out. From July.2004- July.2007, We performed 17 distal pancreatectomies by the laparoscopic approach. These 17 patients were included in the study with varyingly pre-operative diagnosis such as endocrine tumors (5 patients), cystic lesions (6 patients), IPMN (6 patient).The median age was 59.7 years (31-75) with a female to male ratio of 7:10. In addition to 3 port, a hand port was placed in the midline to aid in dissection and the pancreas was divided with a stapler. The resection of the pancreas body was performed with the Echelon(Green 60mm) stapler in almost all our cases.
RESULTS: Of the 17 patients, two were converted to an open procedure due to an uncertain adhesion and inadequate exposure.
The median operating time was 190 minutes (150-280minutes) with a tumor size of 2.5cm (0.5-8cm).
The median time to resuming regular diet and converting to oral pain medications was 2.3 days and 4 days respectively. The length of stay was 13.1 days (5-17).
These were no mortalities. Of the 15 patients that successfully underwent the procedure laparoscopically, and these were no morbidities. With a median follow up of 13.1months (1-27), 4 patients with a diagnosis of malignancy have no evidence of recurrent disease.
Use of the Echelon three-row linear stapler provided closure of the pancreatic duct and hemostasis. No additional procedure, such as the use of sutures or fibrin glue on the pancreatic stump was necessary.
CONCLUSIONS: A minimally invasive approach to pancreatic disease is safe and technically feasible with acceptable morbidity. Our results suggest that laparoscopic distal pancreatectomy is safe and effective for selected patients with benign and low grade malignant pancreatic tumor.The potential advantages of this method include reduced morbidity and reduced hospital stay. Further large series studies with longer follow up are necessary to determine the role of laparoscopic surgery in the treatment algorithm of management of pancreatic disease.
Program Number: P316