Distal pancreas surgery: outcome for 19 cases managed with a laparoscopic approach

Background: In the past decade, laparoscopy has shown its efficacy also for advanced surgery. In this report, the authors retrospectively review their experience with the distal pancreas. Methods: From April 1999 to October 2004, 19 patients underwent a laparoscopic procedure for pathologies of the distal pancreas. The authors performed one distal pancreatectomy (DP) with conservation of the spleen and section of the splenic vessels, four distal spleno-pancreatectornies (DSP), one DSP plus a left adrenalectomy, two enucleations, seven DPs with conservation of the spleen and the splenic vessels, and four cystojejunostomies. Results: One procedure was converted to open surgery because of a hemorrhagic complication. No other significant intraoperative complications occurred. The postoperative course was characterized by one bleed managed conservatively, two pancreatic fistulas (one requiring a second operation), one abscess drained under echographic view, and one reactive pancreatitis. The mean postoperative stay was 8.5 days. The histologic report showed 16 benign diseases and 3 malignant tumors. The mean follow-up period was of 42 months. The patient who had DP spleen preservation with section of the splenic vessels reported mild pain in the left hypochondrium, probably attributable to chronic splenic ischemia, during the first 3 postoperative months. One incisional hernia occurred in the patient who underwent conversion to an open procedure, and one patient affected by adenocarcinoma died 10 months after the operation. Conclusions: The authors can affirm that laparoscopy for the distal pancreas is a successful procedure in terms of results and surgical feasibility. Prospective studies are necessary to confirm their positive impression.