Ressecção laparoscópica dos cistoadenomas pancreáticos

Abstract

-Background -Laparoscopic pancreatic resections have become increasingly frequent with good results reported by several centers. However, few studies have focused on laparoscopic treatment of pancreatic cystic lesions. Aim -To analyze the results of minimally invasive treatment of pancreatic cystic lesions. Methods -Were included all laparoscopic pancreatic resections performed at three centers. Surgical procedures included resection of the pancreas and left enucleations (with or without splenectomy). The post-operative complications were classified according to the classification proposed by Clavien and Dindo6. The diagnosis of pancreatic fistula was confirmed if the amylase dosage of the drainage liquid in the third postoperative day was more than three times the amount of serum amylase. Results -Were performed 44 laparoscopic pancreatic resections. Fifteen patients underwent surgery for suspected pancreatic cystadenoma and 13 had this diagnosis confirmed. There were 12 women (92%), and the average age of patients was 50 years. Six patients had minor postoperative complications. There were five (38%) pancreatic fistulas, neither considered as severe (C), and only one patient required hospital readmission and radiological drainage. In this series, there were no conversions, reoperations, or mortality. Conclusions -The laparoscopic approach is a safe and effective option for the treatment of pancreatic cystic lesions. The incidence of pancreatic fistula has good evolution and not diminishes the benefits of minimally invasive surgery. ABCDDV/866RESUMO -Racional -As ressecções pancreáticas por laparoscopia tem se tornado cada vez mais frequentes, com bons resultados relatados por vários centros. Entretanto, poucos estudos se concentraram no tratamento laparoscópico das lesões císticas pancreáticas. Objetivo -Analisar os resultados do tratamento minimamente invasivo das lesões císticas pancreáticas. Métodos -Análise retrospectiva de um banco de dados prospectivo multicêntrico brasileiro. Foram incluídas todas as ressecções pancreáticas laparoscópicas realizadas em três centros. Os procedimentos cirúrgicos incluíram enucleações e ressecções do pâncreas esquerdo (com ou sem esplenectomia associada). As complicações pos-operatórias foram classificadas de acordo com a classificação proposta por Clavien e Dindo6. O diagnóstico de fístula pancreática foi confirmado se a dosagem de amilase do líquido de drenagem no 3o dia pós-operatório era superior a três vezes o valor da amilase sérica. Resultados -Foram realizadas 44 ressecções pancreáticas por laparoscopia. Quinze pacientes foram operados com suspeita de cistoadenoma pancreático e 13 tiveram o diagnóstico confirmado. Foram operadas 12 mulheres (92%), e a idade média foi de 50 anos. Seis pacientes tiveram complicações pós-operatórias leves. Ocorreram cinco (38%) fístulas pancreáticas, nenhuma considerada grave (C) e apenas um paciente necessitou re-internação hospitalar e drenagem radiológica. Nesta série não houve conversões, re-operações ou mortalidade. Conc...

Laparoscopic Distal Pancreatectomy With or Without Spleen Preservation: Comparative Analysis of Short and Long-Term Outcomes

“…In Brazil, at our knowledge, this is the first comparative study between the two laparoscopic distal pancreatectomy techniques with and without spleen preservation, according to the splenic vessel preservation technique. As Farah et al 9 as Machado et al 13 described a case series of laparoscopic distal pancreatic procedures with spleen preservation; however, they did not specify the technique or the specific results from this group. In the present study, similarities between the two methods were observed.…”