Total Laparoscopic Central Pancreatectomy with Pancreaticogastrostomy for High-Risk XXXX .

@entity1 @entity788 @entity5 @entity190 @entity660 @entity1141
BACKGROUND: Organ-sparing pancreatic resection is important in prophylactic surgery for @entity5 . There is controversy regarding the optimal surgical approach for @entity660 in the neck or proximal body of the @entity788 . Central compared with distal pancreatectomy is technically more challenging, but preserves more functional pancreatic tissue. Because of the prophylactic nature of the surgery and long survival of @entity1 with benign and borderline malignant lesions, surgeons need to stratify greater importance to surgical morbidity and sparing @entity788 . @entity1 : The @entity1 is a 59-year-old active @entity1 with a symptomatic @entity5 of the @entity788 exhibiting high-risk imaging features. The cyst of 2.2  *  1.8  cm in the body of the @entity788 was impinging on the portal venous confluence. TECHNIQUE: The @entity1 was positioned in the French Position, the lesser sac was opened, and the pancreatic body exposed. A retropancreatic tunnel was created with staple division of the neck. The body was mobilized off the portal vein and splenic vessels transected. A retrogastric pancreaticogastrostomy was sewn through an anterior gastrotomy. The stent was delivered past the pylorus to decrease pancreatic enzymatic activation. Pathology demonstrated a mixed predominantly branch duct IPMN with multifocal high grade @entity1141 and PanIN3. CONCLUSIONS: Laparoscopic ultrasound helps in defining cyst borders, and minimal @entity190 optimizes visualization during the dissection. A minimally invasive pancreaticogastrostomy created through an anterior gastrotomy is technically feasible and safe. This approach can minimize the morbidity of prophylactic pancreatic surgery for @entity1 with @entity5 . Nevertheless, it should not compromise safety, oncologic completeness, or an organ-sparing approach.
