Totally Laparoscopic Roux-en-Y Duct-to-Mucosa Pancreaticojejunostomy After Middle Pancreatectomy A Consecutive Nine-case Series at a Single Institution
To present the results of a series of laparoscopic middle
pancreatectomies with roux-en-Y duct-to-mucosa pancreaticojejunostomy. SUMMARY OF
BACKGROUND DATA: Middle pancreatectomy makes it possible to preserve pancreatic
parenchyma in the resection of lesions that traditionally have been treated by
distal splenopancreatectomy or cephalic duodenopancreatectomy. The laparoscopic
approach could minimize the invasiveness of the procedure and enhance the
benefits of middle pancreatectomy. METHODS: From March 2005 to October 2007, 9
consecutive patients with benign or low malignant potential lesions in the
pancreatic neck or body underwent surgery. Laparoscopic middle pancreatectomy
with a roux-en-Y duct-to-mucosa pancreaticojejunostomy was planned on all of
them. In the first 2 patients, the pancreas was transected by endostapler; in the
last 7, the staple line was reinforced with absorbable polymer membrane. RESULTS:
The intervention was concluded laparoscopically in every case except 1
(laparoscopic-assisted) in which pancreaticojejunostomy was performed by means of
minilaparotomy. Mortality was 0% and perioperative morbidity was 33%, (fistula of
the cephalic stump in the first 2 patients (22%)). The pancreaticojejunostomy
fistula rate was 0%. The median postoperative hospital stay was 5 days (range,
3-41). In the last 7 patients, in which pancreas was transected with staple line
reinforcement material there were no stump fistulas; morbidity decreased to 14%
and the median hospital stay was 4 days (range, 3-30). CONCLUSIONS: Laparoscopic
middle pancreatectomy is feasible and safe. Duct-to-mucosa pancreaticojejunostomy
can be performed safely using this approach. The method of pancreatic transection
seems to be decisive in the incidence of cephalic stump fistulas
