HPB P69 Minimally invasive versus open management of chronic pancreatitis - A systematic review

Abstract

Abstract Background Surgical treatment for chronic pancreatitis (CP) is usually performed via an open approach through drainage (pancreaticojejunostomy) or resection (pancreaticoduodenectomy, Beger) procedures or a combination of both (Frey's procedure). Minimally invasive (laparoscopic, robotic) management for patients with CP represents a technical challenge. The aim of this systematic review is to report the outcomes of these minimally invasive procedures among themselves and compare them with reported data from the literature for open procedures. Methods A systematic literature search using Embase and Medline was performed to identify articles reporting CP. Results Twelve studies with 186 patients undergoing a laparoscopic procedure for their intractable abdominal pain caused by their CP. Sixty-six-point six percent of patients (n=124) underwent a laparoscopic drainage procedure while 33.3% (n=62) had a partial or total resection of their pancreas. Total pain relief was achieved in 66.7–100% following laparoscopic pancreatojejunostomy, 93% following laparoscopic Frey's procedure, 90% following laparoscopic total pancreatectomy and islet transplantation and 70% following laparoscopic distal pancreatectomy. Conclusions Laparoscopic procedures for CP are safe and feasible for a carefully selected group of patients. However, more robust comparisons are required between laparoscopic and open approaches in the form of multi-centre randomised controlled trials.