laparoscopic spleen preserving distal pancreatectomy in pseudopapilar Neoplasms of pancreas.

Evelyn A Dorado, MD

CES University Colombia

INTRODUCTION: Pseudopapillar epithelial tumors of the pancreas are infrequent, with an incidence of 1-2%. They occur especially in young women between 30 to 40 years. They are asymptomatic and are usually diagnosed as an incidental finding. They are located in the body and tail of the pancreas. Radical resection is the treatment of choice, although it is a tumor of low malignant potential, which is determined by the size and the mitotic index and may have relapsed into a 6.2%.

MAIN: to describe the advantages of the minimally invasive surgery in pancreatic pathology with spleen preservation.

MATERIAL AND METHOD: Case 36 years old female patient with hipertension and diabetes mellitus in treatment with hypoglicemic drugs, with BMI of 37 in process of bariatric, during the evaluation for a Sleeve gastrectomy perform an abdominal CT SCAN that shows a solid lesion in the tail of the pancreas of 2 X 3 cm without any other additional finding. Endosonography and puncture indicating a pseudopapilar epithelial cels into the lesion, Endoscopy without lesion. CA 19-9 negative. the patient was evaluated for Gastrointestinal Minimally invasive Surgery and scheduele for laparoscopic distal pancreatectomy with spleen preservation.

RESULTS: In lithotomy position, 5 trocars, the procedure starts with a laparoscopic staging and later opens the lesser SAC evaluated the stomach and body and tail of pancreas. identifies the solid lesion on the tail with 2X3 cm of size. Subsequently identify , dissect and separated by a vassel loop the splenic vessels and preserve it. previously identified the injury leaves a 2 cm border pancreatectomy is performed with blue cartridge 60 mm (2) and , reinforced the suture line with 3/0 vicryl and applies collagenase to prevent pancreatic fistulas. .The dissection is completed with bipolar energy.Close the residual pancreas is left drain. Surgical time 240 minutes ,lost blood 50 cc ,hospital length of stay of 3 days,diet at 12 h postoperatives.According to international guidelines of pancreatic fistula we perform measurement of index of amylase in drain and seric at 3 and 7 days. the 8 day retired the drain. result of the pathology showed a pseudopapillar neoplasm with low mitotic index and 2 cm size, IHQ: CKs-, BETA CATENINA+, EMA-, SINAPTOFISINA-, CROMOGRANIN-, Ki67: 1%

CONCLUSION: laparoscopic pancreatic surgery requires advanced training. The percentage of fistula secondary to pancreatic resection may be 30% . the preservation of the spleen in this type of procedures requires a careful dissection of the vessels. the benefits of laparoscopic surgery are clear: rapid recovery, less pain and safe surgery for cancer.


Session: Poster Presentation

Program Number: P314

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