Laparoscopic Pancreatoduodenectomy in 50 Consecutive Patients with No Mortality: A Single-Center Experience
| Autor: | Izabella Braz Martins da Silva, Marcel Autran C. Machado, T. Basseres, Rodrigo C. Surjan, Fabio F. Makdissi |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Biliary Fistula Total pancreatectomy Operative Time Portal vein 030230 surgery Postoperative Hemorrhage Jejunal loop Single Center Pancreatic surgery Resection Pancreaticoduodenectomy 03 medical and health sciences Pancreatic Fistula Young Adult 0302 clinical medicine Pancreatectomy Medicine Humans Prospective Studies Aged business.industry Length of Stay Middle Aged Conversion to Open Surgery Surgery Pancreatic Neoplasms Survival Rate Dissection Gastric Emptying 030220 oncology & carcinogenesis Digestive tract Female Laparoscopy business |
| Zdroj: | Journal of laparoendoscopicadvanced surgical techniques. Part A. 26(8) |
| ISSN: | 1557-9034 |
| Popis: | Laparoscopic pancreatic surgery has gradually expanded to include pancreatoduodenectomy (PD). This study presents data regarding the efficacy of laparoscopic PD in a single center.This was a single-cohort, prospective observational study. From March 2012 to September 2015, 50 consecutive patients underwent laparoscopic PD using a five-trocar technique. Reconstruction of the digestive tract was performed with double jejunal loop technique whenever feasible. Patients with radiological signs of portal vein invasion were operated by open approach.Twenty-seven women and 23 men with a median age of 63 years (range 23-76) underwent laparoscopic PD. Five patients underwent total pancreatectomy. All, but 1 patient (previous bariatric operation), underwent pylorus-preserving resection. Reconstruction was performed with double jejunal loop in all cases except in 5 cases of total pancreatectomy. Conversion was required in 3 patients (6%) as a result of difficult dissection (two cases) and unsuspected portal vein invasion (1 patient). Median operative time was 420 minutes (range 360-660), and the 90-day mortality was nil. Pancreatic fistula occurred in 13 patients (26%). There was one grade C (reoperated), one grade B (percutaneous drainage), and all remaining were grade A (conservative treatment). Other complications included port site bleeding (n = 1), biliary fistula (n = 2), and delayed gastric emptying (n = 2). Mean hospital stay was 8.4 days (range 5-31).Laparoscopic PD is feasible and safe, but is technically demanding and may be reserved to highly skilled laparoscopic surgeons with proper training in high-volume centers. Isolated pancreatic anastomosis may be useful to decrease the severity of postoperative pancreatic fistulas. Therefore, it could be a good option in patients with a high risk for developing postoperative pancreatic, as well as by less-experienced surgeons. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|