Surgical Endoscopy

, Volume 26, Issue 6, pp 1670–1674 | Cite as

Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study

  • Mohammad Abu HilalEmail author
  • Mohammed Hamdan
  • Francesco Di Fabio
  • Neil W. Pearce
  • Colin D. Johnson



Laparoscopic distal pancreatectomy (LDP) is being increasingly performed with some concerns regarding the cost of the minimally invasive approach. The purpose of this study was to assess the cost-effectiveness of LDP versus open distal pancreatectomy (ODP).


A retrospective clinical and cost-comparison analysis was performed for patients who underwent LDP vs. OPD between 2005 and 2011. Data considered for the comparison analysis were: operative costs (surgical procedure, operative time, blood transfusions), postoperative costs (laboratory testing, hospital stay, complication management, readmissions), and overall costs.


Fifty-one distal pancreatectomies (laparoscopic = 35, open = 16) were performed during the study period. The median operative time was 200 (range, 120–420) min for LDP vs. 225 (range, 120–460) min for ODP (p = 0.93). Median blood loss was 200 (range, 50–900) mL for LDP vs. 394 (range, 75–2000) mL for ODP (p = 0.038). Median hospital stay was 7 (range, 3–25) days in the laparoscopic group vs. 11 (range, 5–46) days in the open group (p = 0.007). Complication rate was 40% for LDP vs. 69% in ODP (p = 0.075). Postoperative intervention was required in 11% of patients after LDP vs. 31% after ODP (p = 0.12). The average operative, postoperative, and overall cost was £6039 (range, £4276–£9500), £4547 (range, £1299–£13937), £10587 (range, £6508–£20303) vs. £5231 (range, £3409–£9330), £10094 (range, £2665–£39291), £15324 (range, £7209–£47484) for the LDP and ODP groups, respectively (p = 0.033; p = 0.006; p = 0.197).


We showed that LDP is feasible and safe without having a negative impact on cost. Extensive experience in pancreatic and laparoscopic surgery is required to optimize surgical outcomes.


Laparoscopy Distal pancreatectomy Cost-effectiveness Comparative study Outcome 



Mr. Mohammad Abu Hilal, Mr. Mohammed Hamdan, Mr. Francesco Di Fabio, Mr. Neil W. Pearce, and Mr. Colin D. Johnson have no conflicts of interest or financial ties to disclose.


  1. 1.
    Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RC 2nd, Scoggins CR, Ahmad S, Kim HJ, Park J, Johnston F, Strouch MJ, Menze A, Rymer J, McClaine R, Strasberg SM, Talamonti MS, Staley CA, McMasters KM, Lowy AM, Byrd-Sellers J, Wood WC, Hawkins WG (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248:438–446PubMedGoogle Scholar
  2. 2.
    Kang CM, Kim DH, Lee WJ (2010) Ten years of experience with resection of left-sided pancreatic ductal adenocarcinoma: evolution and initial experience to a laparoscopic approach. Surg Endosc 24:1533–1541PubMedCrossRefGoogle Scholar
  3. 3.
    Ammori BJ, Ayiomamitis GD (2011) Laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a UK experience and a systematic review of the literature. Surg Endosc. doi: 10.1007/s00464-010-1538-4, 7 Feb 2011
  4. 4.
    Jayaraman S, Gonen M, Brennan MF, D’Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Allen PJ (2010) Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J Am Coll Surg 211:503–509PubMedCrossRefGoogle Scholar
  5. 5.
    Finan KR, Cannon EE, Kim EJ, Wesley MM, Arnoletti PJ, Heslin MJ, Christein JD (2009) Laparoscopic and open distal pancreatectomy: a comparison of outcomes. Am Surg 75:671–679PubMedGoogle Scholar
  6. 6.
    Tiwari MM, Reynoso JF, High R, Tsang AW, Oleynikov D (2011) Safety, efficacy, and cost-effectiveness of common laparoscopic procedures. Surg Endosc 25:1127–1135PubMedCrossRefGoogle Scholar
  7. 7.
    Abu Hilal M, Jain G, Kasasbeh F, Zuccaro M, Elberm H (2009) Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre. Surg Endosc 23:2743–2747PubMedCrossRefGoogle Scholar
  8. 8.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRefGoogle Scholar
  9. 9.
    Waters JA, Canal DF, Wiebke EA, Dumas RP, Beane JD, Aguilar-Saavedra JR, Ball CG, House MG, Zyromski NJ, Nakeeb A, Pitt HA, Lillemoe KD, Schmidt CM (2010) Robotic distal pancreatectomy: cost effective? Surgery 148:814–823PubMedCrossRefGoogle Scholar
  10. 10.
    Vijan SS, Ahmed KA, Harmsen WS, Que FG, Reid-Lombardo KM, Nagorney DM, Donohue JH, Farnell MB, Kendrick ML (2010) Laparoscopic vs open distal pancreatectomy: a single-institution comparative study. Arch Surg 145:616–621PubMedCrossRefGoogle Scholar
  11. 11.
    Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC 3rd, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210:779–785, 786–787.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Mohammad Abu Hilal
    • 1
    • 2
    Email author
  • Mohammed Hamdan
    • 1
  • Francesco Di Fabio
    • 1
  • Neil W. Pearce
    • 1
  • Colin D. Johnson
    • 1
  1. 1.Hepatobiliary-Pancreatic and Laparoscopic Surgical UnitSouthampton University Hospitals NHS Foundation TrustSouthamptonUK
  2. 2.University Surgical Unit, F LevelSouthampton General HospitalSouthamptonUK

Personalised recommendations