Laparoscopic pancreatoduodenectomy in 50 consecutive patients with no mortality: How to beat the learning curve?

Abstract

Background: This study presents results regarding initial use of laparoscopic pancreatoduodenectomy (PD) in a single center. Methods: From March 2012 to September 2015, 50 consecutive patients underwent laparoscopic PD. Reconstruction of the digestive tract was performed with double jejunal loop technique whenever feasible. Patients with portal vein invasion were operated by open approach. Results: 27 women and 23 men with a median age of 63 ys underwent laparoscopic PD. 5 underwent total pancreatectomy. All but one 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. Median operative time was 420 min and 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. Conclusion: 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.