Original Article Difficulties and countermeasures of laparoscopic pancreaticoduodenectomy: report of 18 cases

Objective: In this study, we aimed to investigate the difficulties and countermeasures related to laparo - scopic pancreaticoduodenectomy (LP). Methods: A retrospective analysis was performed on the surgical methods and clinical data of 18 LP cases at our hospital between December 2009 and November 2013. Results: All 18 surgeries were completed successfully. The operation time was 465 ± 93 min, and the intraoperative blood loss was 380 ± 216 mL. All cases had negative surgical margins, and there were 14.3 ± 6.7 pieces of scavenged lymph nodes. Postoperative complicating pulmonary infection occurred in 1 case that resolved after enhancement of anti-infectious activity. Mal-healing of incisions occurred in 1 case, and a second-stage suture was performed. Seroperitoneum accompanied with infection occurred in 1 case, and reoperative drainage was performed. Bile leak- age occurred in 2 cases that resolved after drainage, and pancreatic leakage occurred in 2 cases, presenting as secondary intra-abdominal bleeding in 1 case that was treated with reoperation for hemostasis; in the other case, pancreatic leakage resolved after drainage. Conclusions: Improvements in the surgical approach, uncinate process resection, and pancreaticojejunostomy could improve the feasibility and safety of LP.