gms | German Medical Science

Introduction: The technique of laparoscopic distal pancreatectomy (LDP) has been well investigated, both with resection of the spleen as well as with splenic preservation. Because of the considerably lower surgical trauma and the resulting advantages for the patient a laparoscopic approach with feasible histology seems attractive. If suitable the combination of LDP with splenic preservation is preferable due to reduced morbidity.

On the other hand the procedure can be considered technically challenging. In a first small series we want to investigate the technical feasibility and postoperative outcome of such an approach.

Material and methods: A retrospective chart review was performed in all patients who underwent attempted laparoscopic distal pancreatectomy with splenic preservation at Krankenhaus der Augustinerinnen in Cologne from 2011 to 2013.

All operations were performed with Ligasure and Endo-GIA.

The major aspects were operation time and blood loss, postoperative pain scores, length of hospital stay and postoperative complications.

Results: There were 6 cases of LDP performed in our institution since 2011. In all cases splenic preservation was achieved. Indications for surgery included 4 cystic neoplasms, 1 insulinoma and 1 patient with neuroendocrine tumor. This patient has been operated in our clinic on a cystic neoplasm the year before and could again be operated by laparoscopic spleen preserving pancreas resection, although it was revision surgery.

There were 4 females (one case was operated twice) and 1 male with a median age of 54 (range of 38-69).

Median operating time was 145 minutes (range of 123-163) and median blood loss was below 100 ml. No transfusion were needed.

The median visual analogue scale (VAS) was less than 3 from the first day after operation throughout the hole hospital stay in all patients.

Median hospital stay was 12 days (range of 8-21). One extended stay was due to the need for adjustment of glucose metabolism. The other prolonged stay was due to an extended monitoring in a patient with myocardial infarction 6 month previously.

Pancreatic leak didn’t occur in any patient. Conversions were not necessary, all 6 operations could be completed without intra- or postoperativ complications.

Conclusion: There is sufficient data from clinical trials to confirm that laparoscopic partial resection of pancreas with or without splenic preservation appears to be a safe and feasible procedure in patients with benign or noninvasive lesions of the pancreas. Splenic preservation should be performed when technically possible in order to decrease the morbidity of LDP.

The major advantages of the laparoscopic approach are reduced surgical trauma, reduced blood loss, less postoperative pain, lower complication rates and finally a shorter hospital stay. Furthermore there is an avoidance of the long-term risk of post-splenectomy sepsis or syndrome under splenic preservation.

So we come to the conclusion that in experienced hands, laparoscopic distal pancreas resection with splenic preservation seems to be a viable option in selected patients with suitable benign and noninvasive lesions.