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2015 ; 2015
(ä): 472906
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gab.com Text
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English Wikipedia
Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant
Disease: Review of the Literature
#MMPMID26240565
de Rooij T
; Sitarz R
; Busch OR
; Besselink MG
; Abu Hilal M
Gastroenterol Res Pract
2015[]; 2015
(ä): 472906
PMID26240565
show ga
Distal pancreatectomy is the standard curative treatment for symptomatic benign,
premalignant, and malignant disease of the pancreatic body and tail. The most
obvious benefits of a laparoscopic approach to distal pancreatectomy include
earlier recovery and shorter hospital stay. Spleen-preserving distal
pancreatectomy should be attempted in case of benign disease. Spleen preservation
can be achieved preferably by preserving the splenic vessels (Kimura technique),
but also by resecting the splenic vessels and maintaining vascularity through the
short gastric vessels and left gastroepiploic artery (Warshaw technique). Several
studies have suggested a higher rate of spleen preservation with laparoscopy. The
radical antegrade modular pancreatosplenectomy has become mainstay for treating
pancreatic cancer and can be performed laparoscopically as well. Evidence on the
feasibility and safety of laparoscopic distal pancreatectomy for cancer is
scarce. Despite the obvious advantages of laparoscopic surgery, postoperative
morbidity remains relatively high, mainly because of the high incidence of
pancreatic fistula. For decades, surgeons have tried to prevent these fistulas
but to date no strategy has been confirmed to be effective in 2 consecutive
randomized studies. Pragmatic multicenter studies focusing on technical aspects
of laparoscopic distal pancreatectomy are lacking and should be encouraged.