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Laparoskopische Pankreaskopfresektion

Machbarkeit und perioperative Ergebnisse

Laparoscopic resection of the pancreatic head

Feasibility and perioperative results

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Zusammenfassung

Hintergrund

Während die Pankreasschwanzresektion sicher und routiniert in zahlreichen Institutionen praktiziert wird, wurden laparoskopische Pankreaskopfresektionen nur von sehr wenigen Chirurgen weltweit und bisher nicht in Deutschland durchgeführt.

Patienten und Methodik

Wir berichten über erste Erfahrungen nach 9 laparoskopischen pyloruserhaltenden Pankreaskopfresektionen (lap-PPPD) von März 2010 bis September 2010. Diese erfolgten als Hybrid-Operation mit kompletter laparoskopischer Resektion und Rekonstruktion mittels Pankreatogastrostomie über den Bergeschnitt. Parameter zum perioperativen Verlauf wurden mit 605 offenen Pankreaskopfresektionen (1997–2010) verglichen.

Ergebnisse

In der Gruppe der lap-PPPD mussten aus onkologischen Gründen bei 3 der 9 Operationen Konversionen durchgeführt werden. Bezüglich der perioperativen Parameter zeigten sich keine signifikanten Unterschiede zwischen offener und lap-PPPD.

Schlussfolgerung

Die laparoskopische Pankreaskopfresektion mit offener Hybrid-Rekonstruktion über den Bergeschnitt verbindet die potenziellen Vorteile einer laparoskopischen Resektion mit der Sicherheit einer offen durchgeführten Pankreasanastomose und kann bereits zu Beginn der Lernkurve ohne Zugeständnisse an Sicherheit oder Operationsdauer durchgeführt werden.

Abstract

Background

Whereas pancreatic tail resection is routinely and safely performed in several institutions, laparoscopic resection of the pancreatic head is only performed by a handful of surgeons worldwide, none of them in Germany.

Patients and methods

We review our experience with 9 laparoscopic pancreatic head resections (lap-PPPD) performed between March and September 2010. The operations were performed using a hybrid approach with complete laparoscopic pylorus-preserving pancreatic head resection and successive reconstruction via a small retrieval incision. Perioperative outcome was compared to 605 open pancreatic head resections (1997–2010).

Results

In the group lap-PPPD 3 out of 9 conversions had to be performed due to oncologic reasons. There were no significant differences in perioperative outcome when comparing open-PPPD to lap-PPPD.

Conclusion

Laparoscopic pancreatic head resection with hybrid open reconstruction combines the potential advantages of laparoscopic resection with the safety of an open pancreatic anastomosis. Even at the beginning of the learning curve the procedure can be performed with no concessions to safety or duration of the operation.

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Authors and Affiliations

  1. Abteilung Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland

    T. Keck MBA, U. Wellner, S. Küsters, F. Makowiec, O. Sick, U.T. Hopt & K. Karcz

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  1. T. Keck MBA
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  2. U. Wellner
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  3. S. Küsters
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  4. F. Makowiec
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  5. O. Sick
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  6. U.T. Hopt
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  7. K. Karcz
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Correspondence to T. Keck MBA.

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Keck, T., Wellner, U., Küsters, S. et al. Laparoskopische Pankreaskopfresektion. Chirurg 82, 691–697 (2011). https://doi.org/10.1007/s00104-010-2046-8

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  • DOI: https://doi.org/10.1007/s00104-010-2046-8

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