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2006 Abstracts: Laparoscopic pancreaticoduodenectomy- a single centre experience of 35 cases
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Laparoscopic pancreaticoduodenectomy- a single centre experience of 35 cases
Chinnuswamy Palaninvelu, Palanisamy Senthilnathan, S Rajapandian, P S Rajan; Department of Surgical gastroenterology & Minimal Access Surgery, GEM Hospital India Pvt Limited,, Coimbatore, India

Background: In this fast growing laparoscopic era more and more complex challenging surgeries have been performed by laparoscopic method. Pancreaticoduodenectomy is one of the most important among all. So far very few literature have been published describing this procedure. The aim of this article is to emphasis the technically feasibility of laparoscopic pancreaticoduodenectomy(Whipple’s procedure) and their added advantages over the conventional open method. Methods:All patients (35) who had undergone laparoscopic Whipple’s procedure during April 1998 to June 2005 at Coimbatore Institute of Gastrointestinal Endo Surgery (CIGES), GEM hospital were included. Among them 19 were males and 16 were females. Age varies from 28 to 63. Mean age was 48.7. The indications include ampullary growth, early carcinoma head of pancreas, small distal CBD growth and duodenal carcinoma. Results:Mean duration of surgery is 6.4 hours (400 minutes). The average blood loss was 395ml. The mean post operative high dependency unit (HDU) stay was 3.2 days and the average hospital stay was 10.2 days. The post operative complications were drastically reduced when compared to open method. Most of them passed flatus after 48 hours. Nasogastric aspiration was <50ml in 48 hours and thus removed. Oral fluids started on the 3rd or 4th post operative day. None of them had post operative pulmonary complications like atelectasis or pneumonia. There were two pancreatic leaks in my series so far. One of the patients developed features of cholangitis which was subsided with change of antibiotics. Most of them passed flatus after 48 hours. Oral fluids started on the 3rd or 4th post operative day. Wound infection was virtually absent. None of them had post operative pulmonary complications like atelectasis or pneumonia. There were two pancreatic leaks in my series so far. One of the patients developed features of cholangitis which was treated with antibiotics.One of the patients had prolonged gastric stasis for which we did laparotomy on the 12th post operative day.Morbidity has been well reduced to 10-20% when compared to 40-60% of open method. Conclusion: The outcome to date, including ours are encouraging, and we conclude that with advanced instrumentation and improved skills, laparoscopic pancreaticoduodenectomy is feasible and requires further training and education.


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