| Popis: |
Laparoscopic pancreatic surgery underwent many changes in the last few years. Current indications include staging laparoscopy for pancreatic neoplasms, palliative treatment of non-resectable tumors, and pseudocysts drainage. Pancreatic tail resection or pancreatic enucleation have also been reported, but are currently under investigation. We report our experience in this domain.Retrospective study of patients who had a pancreatic tail resection or pancreatic enucleation, in a single institution.From November 1993 to June 2002, a laparoscopic pancreatic resection was attempted in 22 patients. Nineteen patients were operated by laparoscopy (86%), two patients had conversion to laparotomy (9%), and one had conversion to a "hand-assisted" technique (4%). There was 17 left pancreatectomies and five enucleations. Median operating time was 4.1 hours (range 1.6 to 6.6 hours). There were no deaths in the first 30 post-operative days. Global morbidity rate was 31.8% (N =7), including four pancreatic fistulas (18%), one superficial phlebitis, one prolonged ileus, and one peri-pancreatic fluid collection. Median hospital stay was six days (1 to 26 days). CONCLUSION. - Pancreatic tail resections and enucleations are feasible by laparoscopy, with a mortality and morbidity rate similar to open surgery. The potential advantages of laparoscopy (reduced post-operative pain, hospital stay and recovery time) should be balanced with a potential increase in pancreatic fistula rate. That risk should be addressed before laparoscopy is generalized for pancreatic resections. |
