-Case Reports-

Successful Laparoscopic Pancreaticoduodenectomy for Intraductal Papillary Mucinous Neoplasm: A Case Report and a Reliable Technique for Pancreaticojejunostomy

Yoshiharu Nakamura, Satoshi Matsumoto, Masato Yoshioka, Tetsuya Shimizu, Kazuya Yamahatsu and Eiji Uchida

Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School

Like other forms of laparoscopic surgery, laparoscopic pancreaticoduodenectomy (Lap-PD) is a minimally invasive procedure that can greatly reduce bleeding during surgery. We performed Lap-PD for a case of intraductal papillary mucinous neoplasm. To remove the resected tissue from the body, we made a small incision directly above the line of transection of the distal pancreas (the cut stump). This procedure requires complex reconstructive procedures, which we performed through the same small incision. All reconstructive procedures, except for hepaticojejunostomy, were performed under direct visualization; hepaticojejunostomy was performed laparoscopically. The reconstructive surgery was effective and was as safe as open abdominal surgery. We also discuss the value of using an endoscopic linear stapler for Lap-PD pancreatic transection, to reduce extravasation of pancreatic fluid into the abdominal cavity during the resection of tumors involving the pancreatic ducts, such as intraductal papillary mucinous neoplasm.

J Nippon Med Sch 2012; 79: 218-222

Keywords
pancreaticoduodenectomy, laparoscopic surgery, pancreatic transection, reconstruction, intraductal papillary mucinous neoplasm

Correspondence to
Yoshiharu Nakamura, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
keishun@nms.ac.jp

Received, October 12, 2011
Accepted, October 22, 2011