LAPAROSCOPIC SPLEEN-PRESERVING LEFT PANCREATECTOMY WITH SPLENIC VESSELS PRESERVATION: THE DOUBLE-HANGING MAN?UVRE
EAES Online Library. Poves Prim I. Jan 10, 2012; 20065
Dr. Ignasi Poves Prim
Dr. Ignasi Poves Prim
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Abstract
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Introduction: When comparing with open approach, laparoscopic left-sided pancreatectomy (LLP) has been associated with less morbidity (same pancreatic fistula rate) and shorter hospital stay. Management of intraductal papillary mucinous neoplasia (IPMN) is controversial. IPMNs larger than 3 cm and/or sympotmatics should be resected because of the risk of becoming malignant. When LLP is done for the treatment of benign or pre-malignant tumours, spleen should be preserved. Higher morbidity and late complications are associated when the spleen is preserved without preserving the splenic vessels (Warshaw technique). Video presentation: A 73-years old woman was diagnosed of having a 35 mm polilobulated cystic tumour in the neck of the pancreas. Citology showed cellular atypia (“borderline” IPMN). Intracystic CEA was 3227 ng/ml. In the video are exposed, step by step, all the phases for doing a spleen-preserving LLP preserving the splenic vessels. The gastroduodenal and common hepatic artery were identified. The neck of the pancreas was exposed and dissected. A band was placed wrapping the neck of the pancreas (first hanging manœuvre). The inferior border of the pancreas was moved from right to left identifying the splenic vein in all its way. In the union of the body and tail another band was placed wrapping the body of the pancreas (second hanging manœuvre). Pulling up both bands at one time (double hanging manœuvre), the pancreas could be lift up and splenic vessels (artery and vein) easily spared. The neck of the pancreas was divided with endostapler (2.5 mm cartridge) after all the pancreas was completely moved. The stapled line was reinforced using a running suture (Monocryl 2/0). Cholecystectomy because of cholelithiasis was done. Total operative time was 208 minutes. The specimen was removed, protected in a bag, through a Pfannestiel incision. The patient was discharged on 4th postoperative day without complications. Definitive diagnosis was IPMS with three small focus of carcinoma (1.5 mm). All pancreatic margins and removed lymph nodes were negatives. Conclusions: Preserving splenic vessels during a spleen-preserving LLP uses to put surgeons in troubles. The described double hanging manœuvre can help and facilitate the procedure.
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