Two Cases of Laparoscopic Pancreaticoduodenectomy in the Sophisticated and Complicated Situations (with Video)

• Published in: Sichuan da xue xue bao. Journal of Sichuan University. Yi xue ban Vol. 51; no. 4; p. 457
• Main Authors: Gao, Pan, Li, Yong-Bin, Cai, Yun-Qiang, Cai, He, Wang, Xin, Peng, Bing
• Format: Journal Article
• Language: Chinese
• Published: China 01.07.2020
• Subjects: Acute Disease; Aged; Anastomosis, Surgical; Humans; Laparoscopy; Male; Middle Aged; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - methods; Pancreatitis - surgery; Portal Vein - surgery; Treatment Outcome; Vascular reconstruction; Laparoscopic pancreaticoduodenectomy; Sophisticated and complicated situations; Abdominal adhesions; Chronic pancreatitis
• ISSN: 1672-173X
• DOI: 10.12182/20200760501

To explore the individualized surgical strategies and surgical methods which can greatly improve the efficacy and safety of laparoscopic pancreaticoduodenectomy in difficult and complicated situations, such as pancreatic head malignant tumors invade the major vascular and chronic pancreatitis with severe abdominal adhesions. Case 1：A 65-year-old man with jaundice was diagnosed preoperatively with a pancreatic acinus process with superior mesenteric vein (SMV) invasion. In order to ensure R0 resection, the patient underwent laparoscopic pancreaticoduodenectomy combined with SMV resection and reconstruction, taking the way of the superior mesenteric artery (SMA)-first approach. The length of SMV removed was 2 cm (see the Video 1 in Supplemental Contents, http://ykxb.scu.edu.cn/article/doi/10.12182/20200760501). The portal vein (PV)-SMV occlusion time was 26 min, the reconstruction time was 17 min. The duration of the surgery was 340 min, with 200 mL of blood loss and no transfusion. Case 2: A 47-year-old man wi