Laparoscopic Versus Open Distal Pancreatectomy in the Management of Traumatic Pancreatic Disruption

Abstract

Laparoscopy is equivalent to open distal pancreatectomy in children with select traumatic pancreatic injuries.

Minimally Invasive Surgery for Pediatric Trauma—A Multicenter Review

“…1 The initial use of laparoscopy in pediatric trauma focused on its ability to reduce the incidence of negative exploratory laparotomy. [1][2][3][4] As experience with MIS has expanded in many disease processes, its role in pediatric trauma has grown to include therapeutic procedures, but the literature remains centered on case reports, 5-8 small series, [9][10][11][12][13] and reviews. 14,15 In order to characterize the contemporary practice patterns incorporating the use of MIS for trauma, we performed a multicenter center review from six pediatric trauma centers in the United States.…”

Role of ERCP in pediatric blunt abdominal trauma: A case series at a level one pediatric trauma center

“…[2,6] This small number of patients in our series also compares favorably with laparoscopic distal pancreatectomy. [19] The shorter LOS compared to the Houben ERCP study (28 days) was likely due to earlier ERCP and quicker initiation of enteral feeds in our series. [17] Complication rates were similar with two pseudocysts in each series.…”

“…The CT diagnosis is similar to other series, but our study has a higher rate of handlebar injury than many pediatric series. [17][18][19] In our series, like the Canty et al series, ERCP was performed earlier (median post-injury day 2) compared to a median of 5 days in the Houben studies. [2,17] ERCP proved to be diagnostic in all cases, and therapeutic in our series with three of four patients successfully managed with stenting and/or sphincterotomy, with one patient requiring operative intervention despite stenting.…”

Paediatric pancreatic trauma: A review of the literature and results of a multicentre survey on patient management:

“…Some authors advocate conservative management irrespective of the grade of the injury, [1,5,6,11] while others opt for an aggressive surgical approach if the diagnosis is made early on, preferring distal pancreatectomy with splenic preservation. [7,10,12,13] This has been described via both laparotomy and laparoscopy. [13] The alternative approach is stent insertion after diagnostic ERCP, in which the stent is inserted across the duct if possible, or alternatively into the peripancreatic fluid collection associated with the ductal defect.…”

“…[7,10,12,13] This has been described via both laparotomy and laparoscopy. [13] The alternative approach is stent insertion after diagnostic ERCP, in which the stent is inserted across the duct if possible, or alternatively into the peripancreatic fluid collection associated with the ductal defect. [8,14,15] Other less commonly described techniques include creation of a Roux-en-Y jejunal onlay, primary ductal repair and drainage, oversew of proximal pancreatic stump and distal Roux-en-Y pancreaticojejunostomy.…”