Mauricio Zuluaga, General and MIS surgeon1, Ivo Siljic, General and MIS surgeon1, Juan Carlos Valencia, General and MIS surgeon2, Uriel Cardona, General and MIS surgeon2. 1IJP Colombia, Hospitla Universitario Del Valle, Universidad Del Valle, 2IJP Colombia, Clinicafarallones, Clinica Desa, Cali Colombia
Introduction: Chronic pancreatitis is a benign, irreversible inflammatory disorder characterized by the conversion of the pancreatic parenchyma into fibrous tissue. Initial management should be conservative, surgery is applied in case of failure of medical treatment. The development of minimally invasive techniques has made it possible to perform these highly technical procedures in a laparoscopic manner.
Materials and method: We have the history of 2 patients with 19 and 42 years with chronic pancreatitis and pancreatic lithiasis of difficult handling but intractable pain to those who decided to surgical management.
We performed the procedure under general anesthesia, epidural analgesia catheter was placed. Neumoperitoneum technique of cali, at 14 mmHg and approach using a 12 mm umbilical port, 2 working ports of 12 and a 1 of 5 mm port,. The pancreas was exposed by a section of the gastrocolic ligament with a 5mm ultrasonic scalpel, with cephalic retraction of the stomach, opening of a smaller sac and approaching the transpavity of omentum. The ventral surface of the pancreas was exposed from the neck. An incision was made in a pancreas body with a monopolar hook. Primary pancreatic duct lumen was identified and the incision was extended longitudinally from the neck to the tail of the pancreas (8 cm). Roux's Y loop was prepared 50 cm from the Treitz ligament, with a jejunum section with a 60 mm stapler, Roux's loop was transmecoscopically retrocollic, closing the gap of the mesocolon with Monocryl. A 60-cm jejunum-jejunal anastomosis was performed with Endo-GIA stapler and closure of enterotomy with 2-0 polypropylene intracorporeal suture. Jejunal (Roux) isoperistaltic loop was placed longitudinally at the opening of the main pancreatic duct, and enterotomy was performed with monopolar in antimesenteric segment. The intracorporeal pancreatico and jejunum anastomosis was performed using a lower and an upper plane, with single points of total thickness with ethnobond 2-0. 1 closed drains were placed towards each anastomosis. this procedure was performed in the 2 patients reported.
Operative time 180-300min
operative time 4-7 days
drains No1 retired in both cases at 7 days
1 year follow-up of patients improved pain\
Minimally invasive surgery is a fundamental tool for the approach and management of patients with biliopancreatic pathologies. the establishment of multidisciplinary groups, offer an excellent alteranativa in the integral management of the patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87982
Program Number: P134
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster