Laparoscopic Median Pancreatectomy for select mid body tumors Our indications, technique and results

C Palanivelu, MS, MCh, FACS, P Senthilnathan, MS, FACS, R Parthasarathi, MS, P Praveen Raj, MS, V P Nalankilli, MS, S Balamurali, MS, S Srivastan, MS. GEM Hospital & Research Centre, Coimbatore, INDIA.

Introduction:
Conventional pancreatic resections may be unnecessary for mid body tumors of the pancreas that are benign or of low malignant potential. Median pancreatectomy is an option that has been investigated in the management of such tumors. Our objective of this study is to evaluate the feasibility and safety of laparoscopic median pancreatectomy.

Method:
14 patients including 8 females and 6 males, age group ranging from 13 to 79 years underwent laparoscopic median pancreatectomy during the period of October 2003 to October 2012. All patients underwent CT scan of the abdomen. Tumours located in the body of pancreas were chosen, tumours more than 3 cm or with suspicion of malignancy were excluded.

Results:
Tumours included 10 mucinous cystadenomas, 4 serous cystadenomas . The proximal pancreatic remnant was suture ligated. The distal pancreatic end was anastomosed to a Roux-en-Y jejunal loop. The mean operative time was 240 minutes. Mean blood loss was around 160 ml (range 30-320 ml). Mean Post op Icu stay was one day and overall hospital stay was around 4.5 days. There were no mortalities, no major post op complications, however 2 patients had a pancreatic fistula ISGPF Grade A and were managed conservatively. Margins were negative in all cases and with a mean follow up of 2 years no recurrence has been reported till date.

Conclusion:
Laparoscopic central pancreatectomy is a feasible and safe procedure which preserves the parenchymal function. The minimally invasive approach ensures an adequate treatment despite requiring the expertise of highly skilled laparoscopic surgeons

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