Pancreaticogastrostomy During Laparoscopic Pancreaticoduodenectomy; A Viable Alternative to Pancreaticojejunostomy.

E M True, MD, J R Debord, MD, J S Marshall, MD. University of Illinois College of Medicine – Peoria, Department of Surgery


Laparoscopy has changed the approach to many operative interventions. Due to its complexity, minimally invasive surgeons have been slow to adopt laparoscopic pancreaticoduodenectomy (PD). Since the early 1990s, there have been reports of the success and feasibility of laparoscopic PD. Differing methods to perform laparoscopic PD are emerging with increasing experience in the surgical community. In the case of pancreatico-enteric anatomosis, pancreaticogastrostomy (PG) is a viable option compared to pancreaticojejunostomy (PJ) in open PD. This series is the first reported of completely laparoscopic PD performed with a PG rather than a PJ.

A retrospective chart review was performed from 9/2008 to 9/2011. 19 patients were identified as candidates for laparoscopic PD after pre-operative evaluation. Patients then underwent attempted laparoscopic PD. PG was performed totally laparoscopically using a single layer, mattress technique. Outcomes of operative time, estimated blood loss (EBL), length of hospital stay (LOS), peri-operative (30 day) mortality, number of retrieved lymph nodes, rate of pancreatic fistula, and rate of conversion to open procedure were analyzed. These were compared to the current literature.

The patient group was predominantly male (74%) with a mean age of 68.9 years. Conversion to an open procedure occurred in 4 cases (21%). In the 15 cases without conversion; mean operative time was 354 minutes, mean EBL was 430 mL, and the mean length of stay was 13.6 days. One mortality was observed in the peri-operative period (6.7%). The mean number of lymph nodes removed was 12.5. Two patients (13.3%) were diagnosed with a pancreatic fistula. These resolved spontaneously with conservative, medical management.

Operative time (355min vs 378min) and rate of pancreatic fistula (13.3% vs 15%) were lower than an average of other published series. LOS (13.6 days vs 12 days), EBL (430mL vs 189mL), rate of conversion to open (21% vs 9%), and peri-operative mortality were higher (6.7% vs 2%). Number of lymph nodes removed (12.5 vs 15) was lower. Results are comparable to prior series of similar size. The possibility of decreased operative time and rate of pancreatic fistula could positively impact morbidity after PD. This makes PG during laparoscopic PD a technique worthy of further investigation. Larger, randomized trials are warranted to determine statistical significance.

Session Number: Poster – Poster Presentations
Program Number: P374
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