Abstract
Background
Even though more and more cases of laparoscopic central pancreatectomy (LCP) are reported (Machado et al. in Surg Laparosc Endosc Percutan Tech 23(6):486–490, 2013; Hong et al. in World J Surg Oncol 10:223, 2012; Gonzalez et al. in JOP 14(3):273–276, 2013, Zhang et al. in J Laparoendosc Adv Surg Tech A 23(11):912–918, 2013; Sucandy et al. in N Am J Med Sci 2(9):438–441, 2010; Sa Cunha et al. in Surgery 142(3):405–409, 2007), the management for pancreatic stumps remains the most technically challenging part which is the same as in pancreatoduodenectomy (PD), making it the bottleneck for laparoscopic pancreatic surgery. In open surgery, various pancreatic reconstruction techniques designed for either pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG) have been attempted to reduce the postoperative pancreatic fistula (POPF), including the binding anastomosis, invented by our team, i.e., binding PG (BPG) and binding PJ, which have been proved to be effective to reduce the POPF (Hong et al. 2012; Peng et al. in Ann Surg 245(5):692–698, 2007; Peng et al. in Updates Surg 63(2):69–74, 2011). However, despite of this, few reports are seen addressing such technique for laparoscopic surgery even though laparoscopic pancreatic surgery is more performed. After a previous successful laparoscopic BPG in a case of laparoscopic CP (LCP; Hong et al. 2012) and more than 50 cases of open PD and CP (Peng et al. 2011), we further performed laparoscopic BPG in 10 consecutive cases of LCP with satisfactory outcomes.
Objective
To explore the feasibility and efficacy of LCP with BPG.
Methods
Between October 2011 and July 2014, LCP with laparoscopic BPG was performed in ten consecutive patients with lesions of benign or low malignancy at the pancreatic neck. Operative and pathological data, complications, hospital stay and details on the surgical techniques were introduced.
Results
The operations were successfully performed in all the ten cases, with no conversions. The tumor size ranged from 2.0–3.0 to 2.5–3.0 cm, average (2.50 ± 0.35) to (2.66 ± 0.35) cm, and the diameter of pancreatic duct was (1.6–2.1) mm, average (1.71 ± 0.17) mm. Operation time was 170–250 (198.50 ± 25.82) min, and blood loss was 20–300 (125 ± 107.31) mL. Three cases had grade A pancreatic fistula (PF), and one case had delayed gastric emptying, which were all managed with conservative treatment. Upper GI bleeding occurred in one case which was cured with second operation, time for the recovery of bowl movement was 3–5 (4.2 ± 0.8) days, the time for semifluid dieting was 6–10 (8.2 ± 1.5) days, and the hospital stay was 8–20 (12.8 ± 4.63) days. The postoperative fast blood sugar was (6.3 ± 1.6) mmol/L with the normal diet, which was not significantly different from the preoperative data (5.3 ± 0.5) mmol/L (P > 0.05). The postoperative pathology was as follows: five cases of cystic serous adenoma, one case of intraductal papillary mucinous neoplasm, two cases of neuroendocrine tumor, and two cases of solid pseudopapillary tumor of pancreas. All the patients were followed up for 7–40 months, no recurrence happened, and no new incidence of diabetes or insufficiency of pancreatic exocrine function occurred.
Conclusions
LCP with BPG is feasible and safe; the advantages lie in its minimal invasiveness, the efficacy for avoiding PF, and the preservation of the pancreatic endocrine and exocrine function insufficiency, making it an ideal procedure for the benign or low-malignant lesions at the pancreatic neck.
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Acknowledgments
This work was supported by the fund of the Key Project of the Science and Technology Department of Zhejiang Province: the establishment, evaluation and personalized application of binding pancreatojejunostomy/binding pancreatogastrostomy, Fund No: 2013C03046, the Key Funds for the Platform of Medicine of the Health and Family Planning Commission of Zhejiang Province, Nos: 2013ZDA004 and 2015127995, the fund from the Science and Technology Department of Zhejiang Province, No: 2015C33112 and the fund from the Education Department of Heilongjiang Province Government, No: 12511245.
Disclosures
Drs. Defei Hong, Yingbin Liu, Shuyou Peng, Xiaodong Sun, Zhifei Wang, Jian Cheng, Guoliang Shen, Yuanbiao Zhang and Dongsheng Huang have no conflict of interest or financial ties to disclose.
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Hong, D., Liu, Y., Peng, S. et al. Binding pancreaticogastrostomy in laparoscopic central pancreatectomy: a novel technique in laparoscopic pancreatic surgery. Surg Endosc 30, 715–720 (2016). https://doi.org/10.1007/s00464-015-4265-z
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DOI: https://doi.org/10.1007/s00464-015-4265-z