Detailed Abstract
[BP Video Exhibition - Biliary & Pancreas (Pancreas Disease/Surgery)]
[BP VE 29] Laparoscopic Pancreaticoduodenectomy-Is It Possible in Cirrhotic Patient?
K. VIJAYA KUMAR 1, RAJIV MAHARAJ 1, Y. RAGHU NANDAN 1, N. ANAND VIJAI 1, V.P NALANKILLI 1, P. SENTHILNATHAN 1, C. PALANIVELU 1
1 Division of HPB, Minimal Access Surgery And Liver Transplant, GEM HOSPITAL AND RESEARCH INSTITUTE, INDIA
Background : Laparoscopic pancreaticoduodenectomy is challenging procedure, with cirrhotic background still more pressing concern.
Methods : We present a 63 year Female presented with features of Obstructive jaundice for 15 days. Clinical examination revealed hepatomegaly and palpable gallbladder. She's case of HCV related Chronic liver disease patient. MRCP showed dilated CBD and MPD measuring 26mm and 6mm respectively, hypointense lesion 18x28x12 cm in periampullary region. Side viewing scopy was done and biopsy confirmed malignancy. She was taken for laparoscopic pancreatico -dudenectomy. Intraoperatively liver was cirrhotic ,no signs of metastasis. Right Posterior artery first approach was used. Uncinate resection was done using rubber band dynamic traction for mesopancreas complete excision . Pancreaticojejunal anastomosis was done with Modified Baumgart's technique. Hepaticojejunal anastomosis was done with 4-0 PDS .Post operative period was uneventful.
Results : In our series we did 12 cases of Laparoscopic pancreaticoduodenectomy in patients with Liver cirrhosis background. All are Child A patients. 9 periampullary and 3 patients head malignancy.8 pylorus preserving and 4 classical Pancreaticoduodenectomy was done . All patients underwent duct to mucosa Pancreatico-jejunal anastomosis. Median Operative time and blood loss , 460 mins ,250ml respectively.1 patient had GRADE A bleeding managed with blood transfusion,1 had GRADE B bleeding, Angiographic embolization done . 2 patients had GRADE B POPF of which one patient needed relaparotomy and one patient managed with USG guided drainage. All are R0 resections, on Follow up 4 patients died of Cirrhosis decompensation.
Conclusions : Laparoscopic pancreaticoduodenectomy is feasible in selected patient with cirrhotic background ,by experienced surgeon in a tertiary care center.
Methods : We present a 63 year Female presented with features of Obstructive jaundice for 15 days. Clinical examination revealed hepatomegaly and palpable gallbladder. She's case of HCV related Chronic liver disease patient. MRCP showed dilated CBD and MPD measuring 26mm and 6mm respectively, hypointense lesion 18x28x12 cm in periampullary region. Side viewing scopy was done and biopsy confirmed malignancy. She was taken for laparoscopic pancreatico -dudenectomy. Intraoperatively liver was cirrhotic ,no signs of metastasis. Right Posterior artery first approach was used. Uncinate resection was done using rubber band dynamic traction for mesopancreas complete excision . Pancreaticojejunal anastomosis was done with Modified Baumgart's technique. Hepaticojejunal anastomosis was done with 4-0 PDS .Post operative period was uneventful.
Results : In our series we did 12 cases of Laparoscopic pancreaticoduodenectomy in patients with Liver cirrhosis background. All are Child A patients. 9 periampullary and 3 patients head malignancy.8 pylorus preserving and 4 classical Pancreaticoduodenectomy was done . All patients underwent duct to mucosa Pancreatico-jejunal anastomosis. Median Operative time and blood loss , 460 mins ,250ml respectively.1 patient had GRADE A bleeding managed with blood transfusion,1 had GRADE B bleeding, Angiographic embolization done . 2 patients had GRADE B POPF of which one patient needed relaparotomy and one patient managed with USG guided drainage. All are R0 resections, on Follow up 4 patients died of Cirrhosis decompensation.
Conclusions : Laparoscopic pancreaticoduodenectomy is feasible in selected patient with cirrhotic background ,by experienced surgeon in a tertiary care center.
SESSION
BP Video Exhibition
Video Exhibition 3/21/2024 12:00 AM - 12:00 AM