Minimally invasive treatment of walled-off pancreatic necrosis complicated by colonic fistula

Abstract

Objective: Describe the surgical technique used in our hospital. Methods: Surgical technique.The patient is positioned in reverse Trendelenburg. Pneumoperitoneum 15 mmHg, 10 mm optical 30 , three 5 mm trocars and two trocars 12 mm. Harmonic Scalpel is used as an energy device, clips to vessels and section between clips. Extended Kocher maneuver releasing the entire duodenum to the angle of Treitz, to expose vena cava. Gastrocolic ligament section. Dissection through hepatoduodenal ligament and hepatic pedicle, dissection and distal bile duct section. Transection of stomach at antrum level. Transection of jejunum, 10 cm from the Treitz. Section of the gastroduodenal artery. Blunt dissection below the pancreatic neck and the superior mesenteric vein, creating a retropancreatic tunnel, pancreatic section with harmonic scalpel. Child Reconstruction (modified technique). Hepaticojejunostomy and pancreatojejunostomy anastomosis with continuous suture plane, gastrojejunostomy using stapler. The surgical specimen is removed through a suprapubic incision. Results: This is our inicial seri with good results. Conclusion: Laparoscopic pancreaticoduodenectomy should be performed in centers with training in advanced laparoscopic surgery. The advantage of this approach includes less operative bleeding and early recovery, with morbidity and mortality equivalent to the open technique.