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

Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition
Pan GaoBing Peng

Abstract

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 with abdominal pain was admitted with preoperative diagnosis of pancreatic head mass with obstructive jaundice. His past medical history included small bowel resection and bowel anastomosis for abdominal trauma, open Roux-en-...Continue Reading

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