Laparoscopic pancreatic resections: review of feasibility, safety and outcome

Pancreatico-duodenectomy and distal pancreatectomy are the curative resections for pancreatic malignancies. Minimal access resections will reduce the exposure incision whilst facilitating resection with a clear vision.

However surgeon faces a challenging learning curve which is less steep for distal resection compared to pancreaticoduodenectomy. In laparoscopic pancreatico-duodenectomy resection and anastomosis will be done by laparoscopy. In laparoscopic assisted pancreatico-duodenectomy some or all the anastomoses are performed by a mini-laparotomy.

In the case series presented three distal pancreatectomies were performed without conversion. Twenty three out of thirty two (74%) pancreatico-duodenectomies were converted to open at various stages of resection. Five had complete mobilization, four had complete resection and minilaparotomy anastomosis.

One out of the four had the hepatico-jejunostomy performed laparoscopically. He had a pancreatico-gastrostomy and gastro-jejunostomy by a mini-laparotomy with an incision of about 5cm. Early feeding and mobilization was possible with analgesic requirement being minimal.

Two patients died with in one month in the pancreaticoduodenectomy group recording a mortality of 6%. Except one all had clear resection margins on histo-pathology with lymph node clearance comparable to open surgery. In units performing open pancreatic surgery and conversant with advanced laparoscopy, going through the learning curve for laparoscopic pancreatic surgery is feasible and safe. To compare benefits over the open procedures warrant further recruitment of patients