Srikanth Gadiyaram, Dr, Gaurav Singh, Dr, Yashas H Ramegowda, Dr. Sahasra Hospitals, Center of Excellence for Gastroenterology
Background: Laparoscopic distal pancreatectomy with spleen preservation is one of the standardized procedures in selected cases with distal pancreatic tumors but is technically demanding in the setting of pancreatic trauma when distal pancreatic resection is required. We herein present a video with operative steps
Case report: A 15 year old girl presented 24 hours after trauma to upper abdomen while playing Kabaddi. She was hemodynamically stable and and had guarding and tenderness in her upper abdomen. MDCT of the abdomen revealed minimal hemoperitoneum, no pneumoperitoneum and transected pancreas opposite the vertebral body (grade IV pancreatic injury). She was resuscitated and taken up for emergency laparoscopic exploration. At laparoscopy there was 500 ml of blood in the peritoneal cavity. Lesser sac was opened by dividing gastrocolic omentum with harmonic shears. A large hematoma was seen occupying the space between the transected head and body of the pancreas with extension of the hematoma into the mesocolon and mesentery. There was no obvious duodenal injury. A laparoscopic spleen preserving distal Pancreatectomy was performed in the following steps.
Step 1 – Division of gastrocolic omentum and placement of a gastric traction suture to provide wide exposure of lesser sac.
Step 2 – Evacuation of the hematoma by gentle suctioning.
Step 3 – Careful dissection behind the transected body of pancreas to identify the splenoportal venous confluence.
Step 4 – Progressive division of branches of the splenic vein and artery to the body and tail of pancreas using harmonic shears.
Step 5 – Bagging the specimen and extraction through the 12 mm port site in an endobag.
Step 6 – Fibrin glue injection at the proximal transected surface and drain placement. The operative procedure took 2 hours and 45 minutes.Her post operative period was uneventful. The abdomen drain was removed on the 4th POD. She was discharged on a normal diet on postoperative day 7.
Conclusion: Laparoscopic distal panreatectomy with spleen preservation is feasible and safe in an emergent situation in a hemodynamically stable patient
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93925
Program Number: P042
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster