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> Are major laparoscopic pancreatic resections worthwhile ? A prospective study of 32 patients in a single institute.

Objective : The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic pancreatic major resection for benign and malignant lesions of the pancreas. Summary Background Data: Laparoscopic surgery has been used increasingly as a less invasive alternative to conventional open surgery. Recently, laparoscopic therapy for pancreatic diseases has made significant strides. In the present investigation, pancreatic resection by laparoscopy was studied.

Methods and Patient: A prospective study of laparoscopic pancreatic resections was undertaken in patients with benign and malignant lesions of the pancreas. Over an 8 year period, thirty two patients underwent laparoscopic pancreatic major resection: Twenty one patients underwent left pancreatectomy (one was done in a retroperitoneal approach) and eleven patients had pancreatoduodenectomy (ten Whipple procedure and one total pancreatectomy). All operations were performed in a single institute.

Results: The operations were performed without serious complications. Only one left pancreatectomy was converted to laparotomy due to massive splenic bleeding, and one Whipple was converted due to adhesion to the portal vein. In four of the Whipple operations the resection was performed completely laparoscopically and the reconstruction was done by a small midline incision. There was no operative mortality. In 16 patients of the left pancreatectomy group the spleen was preserved. Mean blood loss was 150 mL and 162 mL, mean operating time was 154 minute and 284 minute, in the left pancreatectomy and Whipple, respectively. Postoperative complications occurred in 5 patients and 3 patients after left pancreatectomy and Whipple, respectively. Two patients after left pancreatectomy needed surgical reexploration due to intraperitoneal haemorrhage and eventration of the extraction site. Two patients after Whipple underwent reoperation one due to intra-abdominal bleeding and the other due to small bowel obstruction. Mean hospital stay was 10.8 days and 13.6 days after left pancreatectomy and Whipple, respectively.

Conclusion: Laparoscopic left pancreatectomy for benign and malignant lesions is feasible, safe and beneficial. With regards to pancreatoduodenectomy, we believe that this procedure should be done only in selected cases and by a highly skilled laparoscopic surgeon. If there is any doubt, an open resection should be done.

Key words: laparoscopy - left pancreatectomy - Whipple operation - Pancreatic resection.

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