Laparoscopic Pancreatoduodenectomy in 50 Consecutive Patients with No Mortality: A Single-Center Experience

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorMACHADO, Marcel Autran C.
dc.contributor.authorSURJAN, Rodrigo C.
dc.contributor.authorBASSERES, Tiago
dc.contributor.authorSILVA, Izabella B.
dc.contributor.authorMAKDISSI, Fabio F.
dc.date.accessioned2016-10-17T16:43:08Z
dc.date.available2016-10-17T16:43:08Z
dc.date.issued2016
dc.description.abstractBackground: Laparoscopic pancreatic surgery has gradually expanded to include pancreatoduodenectomy (PD). This study presents data regarding the efficacy of laparoscopic PD in a single center. Methods: This was a single-cohort, prospective observational study. From March 2012 to September 2015, 50 consecutive patients underwent laparoscopic PD using a five-trocar technique. Reconstruction of the digestive tract was performed with double jejunal loop technique whenever feasible. Patients with radiological signs of portal vein invasion were operated by open approach. Results: Twenty-seven women and 23 men with a median age of 63 years (range 23-76) underwent laparoscopic PD. Five patients underwent total pancreatectomy. All, but 1 patient (previous bariatric operation), underwent pylorus-preserving resection. Reconstruction was performed with double jejunal loop in all cases except in 5 cases of total pancreatectomy. Conversion was required in 3 patients (6%) as a result of difficult dissection (two cases) and unsuspected portal vein invasion (1 patient). Median operative time was 420 minutes (range 360-660), and the 90-day mortality was nil. Pancreatic fistula occurred in 13 patients (26%). There was one grade C (reoperated), one grade B (percutaneous drainage), and all remaining were grade A (conservative treatment). Other complications included port site bleeding (n = 1), biliary fistula (n = 2), and delayed gastric emptying (n = 2). Mean hospital stay was 8.4 days (range 5-31). Conclusions: Laparoscopic PD is feasible and safe, but is technically demanding and may be reserved to highly skilled laparoscopic surgeons with proper training in high-volume centers. Isolated pancreatic anastomosis may be useful to decrease the severity of postoperative pancreatic fistulas. Therefore, it could be a good option in patients with a high risk for developing postoperative pancreatic, as well as by less-experienced surgeons.
dc.description.indexMEDLINE
dc.identifier.citationJOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES, v.26, n.8, p.630-634, 2016
dc.identifier.doi10.1089/lap.2015.0577
dc.identifier.eissn1557-9034
dc.identifier.issn1092-6429
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/16378
dc.language.isoeng
dc.publisherMARY ANN LIEBERT, INC
dc.relation.ispartofJournal of Laparoendoscopic & Advanced Surgical Techniques
dc.rightsrestrictedAccess
dc.rights.holderCopyright MARY ANN LIEBERT, INC
dc.subject.otherinternational study-group
dc.subject.otherpylorus-preserving pancreaticoduodenectomy
dc.subject.otherpancreatic surgery isgps
dc.subject.otherloop reconstruction
dc.subject.otherhospital volume
dc.subject.otherunited-states
dc.subject.othercomplications
dc.subject.otherdefinition
dc.subject.otherresection
dc.subject.otheroutcomes
dc.subject.wosSurgery
dc.titleLaparoscopic Pancreatoduodenectomy in 50 Consecutive Patients with No Mortality: A Single-Center Experience
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.author.externalSURJAN, Rodrigo C.:Sirio Libanes Hosp, Sao Paulo, Brazil
hcfmusp.author.externalBASSERES, Tiago:Sirio Libanes Hosp, Sao Paulo, Brazil
hcfmusp.author.externalSILVA, Izabella B.:Sirio Libanes Hosp, Sao Paulo, Brazil
hcfmusp.citation.scopus8
hcfmusp.contributor.author-fmusphcMARCEL AUTRAN CESAR MACHADO
hcfmusp.contributor.author-fmusphcFABIO FERRARI MAKDISSI
hcfmusp.description.beginpage630
hcfmusp.description.endpage634
hcfmusp.description.issue8
hcfmusp.description.volume26
hcfmusp.origemWOS
hcfmusp.origem.pubmed27115329
hcfmusp.origem.scopus2-s2.0-84981350536
hcfmusp.origem.wosWOS:000380818900009
hcfmusp.publisher.cityNEW ROCHELLE
hcfmusp.publisher.countryUSA
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