Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2016; 22(6): 2142-2148
Published online Feb 14, 2016. doi: 10.3748/wjg.v22.i6.2142
Inferoposterior duodenal approach for laparoscopic pancreaticoduodenectomy
Xiao-Ming Wang, Wei-Dong Sun, Ming-Hua Hu, Gua-Nan Wang, Ya-Qi Jiang, Xiao-San Fang, Meng Han
Xiao-Ming Wang, Wei-Dong Sun, Ming-Hua Hu, Gua-Nan Wang, Ya-Qi Jiang, Xiao-San Fang, Meng Han, Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui Province, China
Author contributions: Wang XM designed and performed the research and wrote the paper; Sun WD designed and surpervised the report; Hu MH designed the research and contributed to the analysis; Wang GN, Jiang YQ, Fang XS, and Han M provided clinical advice.
Institutional review board statement: The study was reviewed and approved by the Affiliated Yijishan Hospital of Wannan Medical College.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that there is no conflict of interest to disclose.
Data sharing statement: No additional data are available.
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: Xiao-Ming Wang, MD, Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu 241001, Anhui Province, China. wxm6901@aliyun.com
Telephone: +86-553-5739219 Fax: +86-553-5739107
Received: May 24, 2015
Peer-review started: May 25, 2015
First decision: June 25, 2015
Revised: August 19, 2015
Accepted: November 19, 2015
Article in press: November 19, 2015
Published online: February 14, 2016
Abstract

AIM: To investigate the advantages of inferoposterior duodenal approach (IPDA) for laparoscopic pancreaticoduodenectomy (LPD).

METHODS: A total of 36 patients subjected to LPD were admitted to the Affiliated Yijishan Hospital of Wannan Medical College from December 2009 to February 2015. These patients were diagnosed with an ampullary tumour or a pancreatic head tumour through computed tomography, magnetic resonance imaging or endoscopic retrograde cholangiopancreatography preoperatively. The cases were selected on the basis of the following criteria: tumour diameter < 4 cm; no signs of peripheral vascular invasion; evident lymph node swelling; and distant metastasis. Of the 36 cases, 20 were subjected to anterior approach (AA; AA group) and 16 were subjected to IPDA (IPDA group). Specimen removal time, intraoperative blood loss and postoperative complications in the two groups were observed, and their differences were compared.

RESULTS: During the operation, 2 cases in the AA group and 2 cases in the IPDA group were converted to laparotomy; these cases were excluded from statistical analysis. The remaining 32 cases successfully completed the surgery. The AA group and IPDA group exhibited the specimen removal time of 205 ± 52 and 160 ± 35 min, respectively, and the difference was significant (P < 0.01). The AA group and IPDA group revealed the intraoperative blood loss of 360 ± 210 mL and 310 ± 180 mL, respectively, but these values were not significantly different. Postoperative pathological results revealed 4 cases of inferior common bile duct cancer, 8 cases of duodenal papillary cancer, 6 cases of ampullary cancer, 13 cases of pancreatic cancer, 3 cases of chronic pancreatitis accompanied with cyst formation or duct expansion, and 2 cases of mucinous cystic tumour in the pancreatic head. The postoperative complications were pulmonary Staphylococcus aureus infection, incision faulty union, ascites induced poor drainage accompanied with infection, bile leakage, pancreatic leakage and delayed abdominal bleeding.

CONCLUSION: In IPDA, probing for important steps can be performed in early stages, surgical procedures can be optimised and operation time can be shortened.

Keywords: Laparoscopic pancreaticoduodenectomy, Surgical approach

Core tip: This study investigated the advantages of inferoposterior duodenal approach for laparoscopic pancreaticoduodenectomy. Results revealed that the inferoposterior duodenal approach can be performed not only to probe for important steps in early stages but also to optimise surgical procedures and shorten operation time.