How to Perform Total Laparoscopic Duodenum-Preserving Pancreatic Head Resection Safely and Efficiently with Innovative T
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ORIGINAL ARTICLE – PANCREATIC TUMORS
How to Perform Total Laparoscopic Duodenum-Preserving Pancreatic Head Resection Safely and Efficiently with Innovative Techniques Defei Hong1, Jian Cheng1,2, Weiding Wu2, Xiaolong Liu1, and Xueyong Zheng1 1
Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Hepatobiliary, Pancreatic and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China 2
ABSTRACT Background. Although rapid progress has been achieved in laparoscopic pancreaticoduodenectomy (PD) over the last decade, laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) remains a challenging surgery that has been rarely reported due to not only requiring complicated pancreaticojejunostomy (PJ) but also ensuring sufficient blood supplies to duodenum and common bile duct (CBD). We completed LDPPHR for 22 patients safely and efficiently with innovative techniques. Patients and Methods. Clinical outcomes, including rate of conversion to laparotomy, time of residual pancreatic duct reconstruction, incidence of postoperative complications, and time of hospital stay, were collected for 22 consecutive patients who underwent LDPPHR with innovative techniques as follows: application of indocyanine green (ICG) to visualize and preserve CBD and the vessels supplying the duodenum and CBD, Hong’s PJ, and pancreatic duct end-to-end anastomosis (ETEA) for the residual pancreas.
Jian Cheng and Defei Hong have contributed equally to this work and were co-first authors.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09233-8) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 28 April 2020 Accepted: 23 September 2020 J. Cheng e-mail: [email protected]
Results. All surgeries were performed successfully under laparoscopy except for one case. The duration of ETEA was significantly shorter than PJ (18.2 ± 5.1 min versus 27.5 ± 8.3 min, p \ 0.05). There was no significant difference in incidence of postoperative complications between the Hong’s PJ and ETEA group. The overall incidence of postoperative pancreatic fistula (POPF) in the Hong’s PJ and ETEA group was 23.5% and 20%, respectively, without grade C fistula. All complications were resolved after conservative treatment. Conclusions. By utilizing intraoperative ICG navigation, LDPPHR is a minimally invasive, safe, and efficient approach for chronic pancreatitis with pancreatic head stones by using pancreatic duct ETEA and benign or lowgrade malignant tumors of the pancreatic head by using Hong’s PJ.
To minimize the high morbidity and mortality associated with major pancreatic resection, especially the Whipple operation, a stomach-, duodenum-, and biliary tree-preserving pancreatic head resection was introduced in 1972 by Beger.1 The low incidence of postoperative complications and mortality as
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