Early management of traumatic pancreatic transection by spleen-preserving laparoscopic distal pancreatectomy

Operative vs nonoperative management of blunt pancreatic trauma in children

“…There were 29 boys (66%) and 15 girls with an average age of 7.3 ± 4.2 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) years. The most common mechanisms of injury were motor vehicle collision (n = 12; 27%), bicycle accidents (n = 11; 25%), and nonaccidental trauma (n = 6; 14%).…”

“…Authors advocating for operative treatment of pancreatic trauma argue that nonoperative treatment results in unnecessary prolongation of hospitalization, inconvenience to patients, and increased incidence of pancreatic pseudocyst, particularly when ductal injury is suspected [3,4,13]. For example, in a study of early resection for patients with main duct transection, Meier et al [3] argue that "early pancreatic resection more expeditiously returns the child to good health and lessens the inconvenience and emotional stress associated with prolonged hospitalization."…”

“…In these children, the median time to final follow-up after injury was 58 days (IQ, 25-256 days), with no difference between patients managed nonoperatively or by resection (P = .11). Eleven children (44%) were managed without resection, and 14 (56%) underwent distal pancreatectomy (13) or Whipple procedure (1). In the nonresection group, there was one negative laparotomy with drains placed in the pancreatic bed, and 2 children had pancreatic drains placed during operation for other injuries.…”

Experience with totally laparoscopic distal pancreatectomy with splenic preservation for pediatric trauma—2 techniques

“…We have previously shown that this may avoid unnecessary exploratory laparotomy in certain cases [19]. Thus, far, published experience with laparoscopic pancreatectomy in pediatric trauma has been limited to case reports; at least one of which required the use of a hand-assist port [20][21][22][23]. Because isolated pancreatic trauma is indeed rare, to our knowledge, our series of 3 patients represents the largest report of totally laparoscopic splenic-preserving distal pancreatectomy for blunt abdominal trauma in the pediatric population.…”

Nonoperative management of pancreatic injuries in pediatric patients

“…12,21 Distal pancreatectomy with preservation of the spleen and its blood supply, is favored for distal duct injuries. 4,22,23 The result of this mode of therapy may be satisfactory, with a relatively short hospital stay and return to normal function. 3,4,22,23 However, Cogbill et al 22 reported high morbidity (45%) and mortality (3%) rates on distal pancreatectomy after trauma.…”