Background : Central pancreatectomy (CP) is a parenchyma-sparing pancreatectomy whose main benefit compared to conventional pancreatic resections is better postoperative endocrine function. CP is, however, a technically complex procedure with a higher postoperative morbidity rate and a higher incidence of pancreatic fistula. When CP is performed laparoscopically, it requires even a high degree of dexterity and technical skills. Distal segment of the pancreas after laparoscopic CP is usually anastomosed to the stomach or jejunum. The authors report a case of laparoscopic central pancreatectomy (LCP) & distal pancreaticojejunostomy (PJ) here with an operative video.

Methods : A 55 years old female was referred to UUH for a 5 cm sized cystic mass in the pancreas body detected on the abdominal ultrasonography and CT during a routine health check-up. The distal pancreatic duct was dilated to 4mm in diameter on MRCP. Serous cystadenoma was suspected. According to a medical record, the mass was 2~3 cm in size 15 years ago, since then she was lost to follow. There was no mention about the size of the pancreatic duct at the time and there was no archive of the old imaging studies. She denied a history of DM and fasting blood sugar level was 89 mg/dl. But her parents and 2 brothers and 1 sister had DM. HBsAg was positive without evidence of chronic liver disease. She chose to have an operation for fear of progression. To preserve pancreatic function, central pancreatectomy with distal pancreaticojejunostomy was performed laparoscopically. Proximal pancreas transection was performed with a stapler and distal transection manually. The distal pancreatic duct was dilated to 4mm in diameter. Laparoscopic intracorporeal distal PJ was performed by duct-to-mucosa method with reinforcement with absorbable polyglycolic acid felt (Neoveil?Gunze LTD, Japan).

Results : Operation time was 425 minutes. Estimated blood loss was 50 ml. Postoperative hospital stay was 6 days. There was no postop complication and no readmission within 90 days. fasting blood sugar level 4 weeks after the operation was 82 mg/dl. Serous cystadenoma was confirmed pathologically.

Conclusions : Laparoscopic central pancreatectomy (LCP) could afford the benefits of the minimally invasive pancreatectomy despite of its surgical difficulty. Laparoscopic duct-to-mucosa PJ seems a reasonable option if the distal p-duct is dilated in LCP.