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Pancreas
PMO-096 Laparoscopic distal pancreatectomy—a tertiary referral centre experience
  1. A Morhan1,
  2. P Griffiths2,
  3. T Brown1,
  4. B Al-Sarireh1
  1. 1Pancreatic Unit, Morriston Hospital, Swansea, Swansea, UK
  2. 2Department of Histopathology, Morriston Hospital, Swansea, Swansea, UK

Abstract

Introduction Laparoscopic distal pancreatectomy was first reported in 1996 and is increasingly employed to remove lesions from the body and tail of the pancreas. The technique has seen a slow progress due to a relatively low volume of caseload, the lack of standardisation in the management of the pancreatic stump and concerns about the ability to achieve negative surgical margins for benign or malignant pancreatic neoplasms.

Methods Data were collected by retrospective review of case notes and histopathological results. 20 patients underwent laparoscopic distal pancreatectomy from April 2009 to January 2012.

Results 20 patients were included in the study, 0.45:1 male: female ratio (nine males, 20 females), mean age 58.55 [range 25–83]. In most cases the indication for surgery was a cystic lesion in the tail of pancreas (45%). The spleen was preserved in 15 cases (75%). None of the patients in this series required conversion from laparoscopic to open surgery or blood transfusion. Four patients (20%) were transferred to HDU postoperatively for 1–5 days and the mean hospital stay was 8.5 days [range 3–23 days]. Four patients (20%) had postoperative complications: one had partial splenic infarction which was managed conservatively, one had fluid collection that was treated by percutaneous drainage, one had a pancreatic stump leak that settled conservatively and one had abscess which required surgical intervention. The latter had laparoscopic right hemicolectomy at the same time of his pancreatic resection. There was no indication of a pancreatic fistula at follow-up. Histology confirmed one chronic abscess, one congenital cyst, five cancers, six potentially malignant lesions and seven serous microcystic cystadenomas. All tumours were completely excised with clear resection margins.

Conclusion Laparoscopic resection is feasible and achieves adequate resection margins.

Competing interests None declared.

References 1. Pierce RA, et al. Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 2007;21:579–86.

2. Abu Hilal M, et al. Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre. Surg Endosc 2009;23:2743–7.

3. Mahon D, et al. Laparoscopic distal pancreatectomy. Three cases of insulinoma. Surg Endosc 2002;16:700–2.

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