Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis.

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OBJECTIVE: The authors performed an initial clinical evaluation of laparoscopic pancreatectomy with splenectomy for chronic pancreatitis. SUMMARY BACKGROUND DATA: Severe intractable pain is the most common indication for resection in chronic pancreatitis. Localized accentuation of the pathology, usually in the head of the organ, is the basis for localized proximal resection, often with preservation of a rim of pancreas and the duodenum, although some favor total pancreatectomy. The reported results for distal pancreatectomy have been variable. Distal resections are limited to those patients in whom the gross pathology is maximal in the left hemipancreas. METHODS: A consecutive series of five patients with intractable pain due to chronic pancreatitis have been treated with laparoscopic 70% distal pancreatectomy and splenectomy using a 5-port technique. RESULTS: The procedure was completed in all with an average operating time of 4.5 hours and a mean intraoperative blood loss of 400 mL. There was one minor pancreatic leak, which resolved spontaneously. The median postoperative hospital stay was 6 days. CONCLUSIONS: Laparoscopic distal pancreatectomy for chronic pancreatitis is feasible, the procedure appears to be safe, and it is accompanied by an accelerated recovery.

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