Re-do Laparoscopic Pancreaticoduodenectomy after Laparoscopic pancreatic surgery

Wei-Wei Jin, MD1, Chao Lu1, Yi-Ping Mou, MD, FACS2, Rong-Gao Cheng1, Jing-Rui Wang1, Xiao-Wu Xu2. 2Division of Gastroentropancreas, Department of General Surgery, Zhejiang Provincial People’s Hospital, 1Medical School, Zhejiang University

Background Laparoscopic pancreatectomy has been gaining acceptance widely with clear mini-invasive advantages. Re-do laparoscopic pancreaticoduodenectomy after laparoscopic pancreatic surgery is a very difficult procedure. The aim of this study is to present the feasibility and safety of re-do laparoscopic pancreaticoduodenectomy after laparoscopic pancreatic surgery.

Methods From September 2013 to December 2014,there were 3 cases undergoing  pure laparoscopic pancreaticoduodenectomy with 5 ports. Of these three patients, a 74-year old male underwent laparoscopic distal pancreatectomy as a diagnosis of pancreatic adenocarcinoma and CT showed a low-density mass in the pancreatic head that considered as pancreatic adenocarcinoma 3 years later. Another 49-year old male underwent laparoscopic pancreatic enucleation for pancreatic neuroendocrine tumor with lymph node metastasis at pancreatic head in 3 months ago. The last one was 45-year old male undergoing laparoscopic pancreatic enucleation for multiple gastrinoma at pancreatic head and surgical exclusion of splenic artery aneurysms without splenectomy, but the symptom did not disappear and MRI revealed multi-mass at pancreatic head.

Results The mean operation time was 366.67 minutes (range, 310-400 minutes), and the blood loss was 183.3 ml (range, 150-200 ml). There were no postoperative complications and the mean postoperative hospital stay was 16 days (range, 13-20 days). Diagnosis was pancreatic adenocarcinoma, pancreatic neuroendocrine tumor and gastrinoma. The mean follow-up was 15 months, and the patients with total pancreatectomy suffered diabetes that was well controlled by insulin.

Conclusion Re-do laparoscopic pancreaticoduodenectomy after laparoscopic pancreatic surgery is feasible and safety in skilled surgeons at selected patients.

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