The Posterior Approach for Laparoscopic Distal Pancreatectomy: A Valid Choice for Resection of Complex Lesions of the Distal Pancreas.

Abstract

Laparoscopic distal pancreatectomy (LDP) is replacing open surgery as the technique of choice for benign and premalignant lesions of the left pancreas. In most laparoscopic series, the supine decubitus or semilateral position is preferred. A posterior approach with the patient in full right lateral decubitus (PA-FRLD) has been proposed as an alternative. From July 2012 to November 2014 we performed 14 LDPs. PA-FRLD was chosen in 8 patients; in 6 patients splenectomy was also performed. Definitive diagnoses were 3 cases of pancreatic ductal adenocarcinoma, 2 cases of nonfunctioning neuroendocrine tumors, 1 case of bulky serous cystic neoplasm, 1 case of inflammatory chronic pancreatitis, and 1 case of pancreatic trauma (duct disruption). No conversions were required. No postoperative pancreatic fistula was detected. No patient required transfusion. Two patients had Clavien II and IIIb postoperative complications. In both cases in which preservation of the splenic vessels was attempted, it was successfully achieved. The PA-FRLD position is a valid alternative to the supine or semilateral position for LDP. This approach is especially beneficial for resection of complex and bulky lesions of the tail of the pancreas and those in close contact with retroperitoneal organs and can also facilitate spleen-preserving LDP.