Orhan BİLGE, Serkan ZENGER, Çağrı BİLGİÇ, Bülent GÜRBÜZ, Erman SOBUTAY, Uğur CAN

Periampuller Bölge Tümörlerinde Laparoskopi Yardımlı Pankreatikoduodenektomi

GİRİŞ ve AMAÇ: Teknolojideki gelişmeler doğrultusunda, morbidite oranlarını azaltmak amacıyla pankreas cerrahisinde de minimal invaziv girişimlerin sayısı giderek artmaktadır. Bu çalışmada, kliniğimizde periampuller bölge tümörlerinde laparoskopi yardımlı pankreatikoduodenektomi uyguladığımız hastaların sonuçlarını paylaşmayı amaçladık. YÖNTEM ve GEREÇLER: Nisan 2014 ile Ağustos 2020 yılları arasında periampuller bölge tümörü nedeniyle laparoskopi yardımlı pankreatikoduodenektomi uygulanan hastaların demografik ve klinik özellikleri, ameliyat verileri, postoperatif sonuçları ve patolojik verileri retrospektif olarak incelendi. BULGULAR: Çalışmaya dahil edilen 30 hastanın 12’si (%40) kadın, 18’i (%60) erkek, ortalama yaşları 64 ± 14 idi. Beş (%13,3) hastada açık yönteme geçildi. Ortalama ameliyat süresi 378 ± 72 dakika ve ortalama hastanede kalış süresi ise 10 ± 4 gündü. Postoperatif dönemde, 7 (%23,3) hastada minor komplikasyon, 4 (%13,3) hastada ise major komplikasyon saptandı. Major komplikasyonlar; 3 hastada grade B pankreatik fistül ve 1 hastada ise karın içi apse idi. Hastaların patolojik tanıları; 20’sinde (%66,7) adenokarsinom, 6’sında (%20) intrapapiller müsinöz neoplazm, 2’sinde (%6,6) solid psödopapiller neoplazm, 1’inde (%3,3) nöroendokrin tümör ve 1’inde (%3,3) ise gastrointestinal stromal tümör idi. Ortalama çıkarılan lenf nodu sayısı 16,5 ± 8,2 idi. TARTIŞMA ve SONUÇ: Laparoskopi yardımlı pankreatikoduodenektomi, lokal komplikasyonları ve morbiditeyi azaltması, hastanede kalış süresini kısaltması gibi minimal invaziv girişimlerin sağladığı avantajlar nedeniyle uygulanabilir bir yöntemdir. Ancak laparoskopi yardımlı pankreatikoduodenektomi için, uygun hasta seçimi ile birlikte bu işlemin laparoskopi konusunda tecrübeli ekipler tarafından uygulanması gerektiği kanaatindeyiz.

Anahtar Kelimeler:

laparaskopi, periampuller tümör, pankreatikoduodenektomi, komplikasyon

Laparoscopic Assisted Pancreaticoduodenectomy in Periampullary Tumors

INTRODUCTION: In line with the developments in technology, the number of minimally invasive procedures in pancreatic surgery is increasing gradually in order to reduce the morbidity rates. We aimed to present the results of the patients who underwent laparoscopic assisted pancreaticoduodenectomy for periampullary tumors in our clinic. METHODS: Data of the patients who underwent laparoscopic assisted pancreaticoduodenectomy for periampullary tumor between April 2014 and August 2020 were retrospectively analyzed. Demographic and clinical characteristics, surgical outcomes, postoperative results and pathological data of the patients were presented. RESULTS: Of the 30 patients, 12 (40%) were female, 18 (60%) were male, and the mean age was 64±14. Laparoscopy was converted open technique in 5 (13.3%) patients. The mean operative time was 378±72 minutes and the mean length of hospital stay was 10±4 days. In postoperative period, 7 (23.3%) patients had minor complications and 4 (13.3%) patients had major complications. Major complications were grade B pancreatic fistula in 3 patients and intraabdominal abscess in 1 patient. Pathological diagnosis of patients were adenocarcinoma in 20 (66.7%) patients, intrapapillary mucinous neoplasm in 6 (20%) patients, solid pseudopapillary neoplasm in 2 (6.6%) patients, neuroendocrine tumor in 1 (3.3%) patient and gastrointestinal stromal tumor in 1 (3.3%) patient. The mean number of harvested lymph nodes was 16.5±8.2. DISCUSSION AND CONCLUSION: Laparoscopic assisted pancreaticoduodenectomy is a feasible method due to the advantages of minimally invasive procedures such as reducing local complications, morbidity, and length of hospital stay. However, we believe that laparoscopic assisted pancreaticoduodenectomy should be performed by teams experienced in laparoscopy in selected patients.

Keywords:

Laparoscopy, periampullary tumor, pancreaticoduodenectomy, complication,

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