Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2015; 21(22): 7047-7051
Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.7047
Laparoscopic fenestration of pancreatic serous cystadenoma: Minimally invasive approach for symptomatic benign disease
Safi Dokmak, Béatrice Aussilhou, Fanjandrainy Rasoaherinomenjanahary, Alain Sauvanet, Marie-Pierre Vullierme, Vinciane Rebours, Philippe Lévy
Safi Dokmak, Béatrice Aussilhou, Fanjandrainy Rasoaherinomenjanahary, Alain Sauvanet, Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, 92210 Clichy, France
Marie-Pierre Vullierme, Department of Radiology, Beaujon Hospital, 92210 Clichy, France
Vinciane Rebours, Philippe Lévy, Department of Gastroenterology, Beaujon Hospital, 92210 Clichy, France
Author contributions: Dokmak S, Aussilhou B, and Lévy P designed and performed the research, contributed new reagents and analytic tools, analyzed the data, and wrote the paper; Rasoaherinomenjanahary F designed the research, contributed new reagents and analytic tools, analyzed data, and wrote the paper; Sauvanet A designed and performed the research, contributed new reagents and analytic tools, and analyzed the data; Vullierme MP and Rebours V designed the research, contributed new reagents and analytic tools, and analyzed the data.
Informed consent: All study participants, or their legal guardian, provided written informed consent prior to study enrollment.
Conflict-of-interest: All authors of this study declare no conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Safi Dokmak, MD, Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, 92210 Clichy, France. safi.dokmak@bjn.aphp.fr
Telephone: +33-1-40875795 Fax: +33-1-40870926
Received: August 18, 2014
Peer-review started: August 20, 2014
First decision: November 14, 2014
Revised: December 29, 2014
Accepted: February 5, 2015
Article in press: February 5, 2015
Published online: June 14, 2015
Abstract

Serous cystadenoma (SC) is a benign pancreatic cystic tumor. Surgical resection is recommended for symptomatic forms, but laparoscopic fenestration of large symptomatic macrocystic SC was not yet described in the literature. In this study, 3 female patients underwent laparoscopic fenestration for macrocystic SC (12-14 cm). Diagnosis was established via magnetic resonance imaging and endoscopic ultrasound, with intra-cystic dosage of tumors markers (ACE and CA19-9) in 2 patients. All patients were symptomatic and operated on 15-60 mo after diagnosis. Radiological evaluation showed constant cyst growth. Patients were informed about this new surgical modality that can avoid pancreatic resection. The mean operative time was 103 min (70-150 min) with one conversion. The post-operative course was marked by a grade A pancreatic fistula in one patient and was uneventful in the other two. The hospital stay was 3, 10, and 18 d, respectively. The diagnosis of macrocystic SC was histologically-confirmed in all cases. At the last follow-up (13-26 mo), all patients were symptom-free, and radiological evaluation showed complete disappearance of the cyst. Laparoscopic fenestration, as opposed to resection, should be considered for large symptomatic macrocystic SC, thereby avoiding pancreatic resection morbidity and mortality.

Keywords: Pancreatic serous cystadenoma, Laparoscopic fenestration, Symptomatic

Core tip: Although surgical resection is the classical modality for treating symptomatic serous cystadenoma (SC), laparoscopic fenestration for large macrocystic SC was not yet described in the literature. In this study, 3 female patients underwent laparoscopic fenestration of symptomatic macrocystic SC. Conversion was needed in one patient for bile duct injury, while another patient developed a grade A pancreatic fistula. Histology confirmed the diagnosis in all patients and, after a follow-up of 13-26 mo, all patients are asymptomatic. Radiological evaluation showed complete disappearance of SC. This mini-invasive approach avoids the high mortality and morbidity encountered with pancreatic resection.