Laparoscopic management of pancreatic lesions in children

Abstract

Background. This review is the representation of our experience of laparoscopic approach to various pancreatic lesions in series of paediatric patients. Material and methods. 45 children aged from 1 month to 16 years diagnosed with congenital anomalies and acquired lesion of the pancreas underwent surgical treatment with the use of laparoscopic techniques. The following laparoscopic procedures were carried out: excision of gastric ectopic pancreas (n-19); external drainage, fenestration or Roux-en-Y cystojejunostomy of pancreatic cyst (n-8); excision of gastric duplication cyst of the pancreas, pancreatic lymphangioma or pancreatic hytatid cyst (n-4); spleen-preserving distal pancreatectomy or central pancreatectomy with distal pancreaticogastrostomy for solid pseudopapillary tumor (n-4); lateral pancreatojejunostomy for chronic relapsing pancreatitis and pancreatic ductal dilatation (n-3); enucleation of insulinoma (3); 95% near total pancreatectomy for congenital hyperinsulinism (3). Results. In 44 (97,7%) patients the undertaken laparoscopic procedures were successfully completed with no intraoperative complications occurred. The conversion to open distal pancreatic resection was required in 1(2,2%) case when laparoscopic dissection was very much complicated due to massive inflammatory changes in the peripancreatic tissue. Postoperatively, 1 (2.2%) patient developed small bowel obstruction due to Rouxen-Y anastomosis kinking which necessitated open anastomotic reconstruction. In 2 (4,4%) patients pancreatic fistula occurred after insulinoma enucleation and were successfully managed with ocreotide treatment. The rest 41 (91,1%) patients made prompt and uneventful recovery. At follow up, no evidence of recurrent pancreatitis or any associated gastrointestinal symptoms were recorded. Conclusion. Laparoscopic surgery for congenital anomalies and acquired lesions of the pancreas in children is feasible and safe if performed by skilled laparoscopic surgeon who should be experienced in the open complex operations on the pancreas.