Laparoscopic enucleation of Branch Duct IPMN of the head of the pancreas

Abstract

Background: Enucleation is a sparing parenchyma procedure for benign lesions or low grade malignant tumors of the pancreas, and when performed for lesions on the head of the pancreas it presents the advantage of avoidance of reconstruction of pancreatic or biliary duct. Most of reports on laparoscopic enucleation are of solid tumors or cystic tumors non communicated with the main pancreatic duct. IPMN’s remains controversial in laparoscopic enucleation. Our aim is to show our results in laparoscopic enucleation of BD IPMN of the head of the pancreas. Methods: A retrospective study from 2012 to 2015 was performed recollecting laparoscopic enucleations of BD IPMN. 5 Patients were included. Surgery indication was made according Sendai Criteria. Results: The mean age of patients was 53 years old. Most indications of surgical intervention were increase in size and pancreatitis. All Cysts were located in the head/uncinated. Malignancy was ruled out by CT scan, MRI and EUS. Frozen section was routine. Final pathology showed mild and moderate side-branch IPMNs. Two patients developed pancreatic leaks (grade A and B), and one patient acute pancreatitis with posterior bleeding that required an angiography. No patients had recurrent cysts or adenocarcinoma with a follow up to present day. Conclusion: In our experience laparoscopic enucleation for BD IPMN’s of the head of the pancreas is feasible and safe in selected cases, avoiding large resections with their respective consequences.