Laparoscopic Distal Pancreatectomy for Acute Pancreatic Transection in a Child

Abstract

Introduction:

Laparoscopy has been shown to have superior results to both nonoperative management and open distal pancreatectomy in children.1 –5 In this article, we report our technique for spleen-preserving laparoscopic distal pancreatectomy.

Operative Technique/Methods:

An 11-year-old BMX bike racer presented after losing control of his bike and falling forward onto the edge of the handlebar hitting his left chest and abdomen. CT scan of the abdomen suggested distal pancreatic transection. He was transferred to our center for definitive management. Endoscopic retrograde cholangiopancreatography was performed in the operative suite 18 hours postinjury confirming transection of the distal pancreatic duct. The patient underwent laparoscopic distal pancreatectomy without splenectomy. The patient was positioned with a large roll under the left torso. The left arm was placed across the chest. Four 5-mm ports were placed: the umbilical port was later converted to a 12-mm port for extraction of the specimen. Once we entered the abdominal cavity, the lesser sac was entered by taking down gastrocolic ligament using the LigaSure. An acute pancreatic pseudocyst was opened and suctioned. We identified the transected ends of the proximal and distal pancreas. The inferior border of the distal pancreas was freed by taking down the attachments and small vessels with a LigaSure device. The upper border attachments to the splenic vein were identified, and the pancreas dissected from the vein, also with the LigaSure. Final peritoneal attachments were taken down using hook monopolar electrocautery. The open end of the proximal pancreas was over sewn with locking 3-0 PDS suture to prevent pancreatic leak. The distal pancreas was placed in a retrieval bag and removed through the 12-mm port. A 15-mm Blake drain was placed in the pancreatic bed.

Conclusion:

Patient recovered well after surgery and was discharged home in a stable condition. The drain was removed at the postoperative visit. This video demonstrates one technique for laparoscopic distal pancreatectomy for acute traumatic injury. Laparoscopic distal pancreatectomy appears to be a feasible and safe approach in acute distal pancreatic transection in children.

No competing financial interests exist.

Runtime of video: 5 mins 53 secs