Single-Incision Laparoscopic Gastrojejunal Bypass with Intraoperative Ultrasonography for Obstructive Pancreatic Head Tumor

Abstract

Introduction:

Pancreatic head tumors can be diagnosed immediately as symptomatic, although the biliary tract is not involved. Gastrojejunal bypass performed by laparotomy ¹ or laparoscopy ² has been used to solve temporally this clinical situation. Recently, single-incision laparoscopy (SIL) has been introduced, and it mainly offers an improved cosmesis. ³ SIL has been reported to be feasible in pancreatic diseases. ^{4 –6} In front of patients presenting an obstructive pancreatic head tumor, SIL can be proposed as a valid option because it allows an early starting of neoadjuvant chemotherapy, due to reduced invasiveness of general laparoscopy.

Materials and Methods:

A 56-year-old man was hospitalized for vomiting and weight loss. Preoperative work-up showed the presence of an advanced and obstructive pancreatic head adenocarcinoma, not interesting the biliary tract. A laparoscopic gastrojejunal bypass with staging laparoscopy, through transumbilical single-access, was proposed to the patient. The technique consisted of the insertion of an 11-mm reusable trocar, two 6-mm flexible reusable trocars, and curved reusable instruments through the same umbilical incision. The procedure started with the exploration of the parietal peritoneum, lavage of the cavity, opening of the lesser sac for perioperative ultrasonography, and ended with linear mechanical side-to-side gastrojejunostomy.

Results:

The obstructive status of the patient resolved during the postoperative course, and the patient started neoadjuvant chemotherapy after 10 days.

Conclusions:

Single-incision laparoscopic gastrojejunal bypass for obstructive pancreatic head tumor, after staging laparoscopy including perioperative ultrasonography, permits to begin neoadjuvant chemotherapy earlier because of reduced invasiveness.

The author is a consultant for Karl Storz-Endoskope, Tuttlingen, Germany

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Runtime of video: 6 mins 5 secs