Application of Mid-Pancreatectomy with End-to-End Anastomosis in Pancreatic Benign Tumors

Summary

The present protocol describes the application of mid-pancreatectomy combined with end-to-end anastomosis in the surgical treatment of pancreatic benign tumors, which presents a feasible solution for managing such tumors while concurrently preserving pancreatic function.

Abstract

Mid-pancreatectomy combined with end-to-end anastomosis is a surgical procedure used to treat benign pancreatic tumors. It involves removing the tumor from the middle section of the pancreas and connecting the proximal and distal ends through an anastomosis. The traditional surgical approach for resecting the middle segment of the pancreas involves closing the proximal pancreas and creating a Roux-en-Y anastomosis with the jejunum. However, this approach carries a double risk of pancreatic stump fistula and pancreatico enteric anastomotic leak postoperatively. In this paper, a new procedure is described where stent tubes were placed into the proximal and distal sides of the pancreatic ducts after ensuring sufficient freedom from the proximal distal pancreas. The pancreatic parenchyma was then sutured continuously under direct vision to achieve pancreatic end-to-end anastomosis. This procedure helps preserve pancreatic function, reducing the risk of postoperative pancreatic insufficiency. However, due to the complexity and risks involved, thorough evaluation and preparation are necessary before surgery. We carefully assess the patient's history, serology, and imaging results to determine the feasibility and effectiveness of the procedure. During surgery, we consider the use of a suitable pancreatic duct stent to ensure the flow of pancreatic juice into the intestine through physiological pathways. Our goal is to remove the tumor while preserving as much normal pancreatic tissue as possible for the anastomosis. After the operation, it is crucial to monitor the patient's pancreatic function, paying close attention to blood glucose levels, drainage fluid volume, and amylase value of the pancreatic anastomosis. During the postoperative follow-up visit, the patient's pancreatic function was assessed, and there was no significant change in quality of life compared to before the surgery. This indicates that mid-pancreatectomy combined with end-to-end anastomosis is a safe and effective procedure for treating pancreatic benign neoplasms.

Introduction

From a clinical perspective, it is important to note that not all tumors that develop in the pancreas are classified as pancreatic cancers. Pancreatic tumors can be broadly categorized into two main groups: benign tumors of the pancreas and pancreatic malignancies. Benign neoplasms of the pancreas encompass cystadenoma, intraductal papillary mucinous neoplasm, pancreatic hemangioma, and others¹. The detection rate of benign pancreatic tumors has been consistently increasing over the years, and surgery remains the most effective treatment option². However, traditional surgical procedures such as pancreatoduodenectomy or b....

Protocol

The operation is routine and has received ethics approval. This study was permitted by the Ethics Committee of the Six Affiliated Hospital of Sun Yat-sen University. Meanwhile, the informed written consent was obtained from the patient. Its research contents and methods meet the medical ethics norms and requirements.

1. Patient selection

1. Use the following inclusion criteria: benign pancreatic tumors, including hemangioma, benign neuroendocrine tumor, serous or muci.......

Discussion

The pancreas, an important digestive organ in the human body, has several important secretory functions. Therefore, in pancreatic surgery, attention needs to be paid to the preservation of pancreatic parenchyma and its function. With the rising detection rate of benign pancreatic tumors and low-grade malignancies, various procedures have been developed to preserve function, including local enucleation of the pancreas, mid-pancreatectomy, and pancreatic head resection with preservation of the duodenum^12<.......

Materials

Name	Company	Catalog Number	Comments
abdominal instrument button	Johnson & Johnson
abdominal instrument cap	Johnson & Johnson
abdominal instrument collar	Johnson & Johnson
abdominal instrument connector	Johnson & Johnson
Absorbable ligature clip	Sichuan Guona Technology Co., LTD	230716
barbs	Johnson & Johnson
blade	Johnson & Johnson
blood pad	Johnson & Johnson
Cloth towel forceps	Johnson & Johnson
disposable drainage tube	Johnson & Johnson	412280	6 cm x 2 mm
Electric knife head	Johnson & Johnson
forceps	Johnson & Johnson
hilt	Johnson & Johnson
holding flask	Johnson & Johnson
intestinal forceps	Johnson & Johnson
laparoscope	Johnson & Johnson
laparoscopic instruments	Johnson & Johnson
Ligating clip	Teleflex Medical	73H2300118
long curved forceps	Johnson & Johnson
medium curved forceps	Johnson & Johnson
Nail clamp	Ethicon,USA	584C82
needle holders	Johnson & Johnson
ovoid forceps	Johnson & Johnson
Paraffin oil	Johnson & Johnson
purse string forceps	Johnson & Johnson
right angled forceps	Johnson & Johnson
right angled forceps	Johnson & Johnson
scissors	Johnson & Johnson
Siphonhead	Johnson & Johnson
Small cup	Johnson & Johnson
small curved forceps	Johnson & Johnson
Sonotome keyhole	Johnson & Johnson
steel ruler	Johnson & Johnson
Straight forceps	Johnson & Johnson
Suction needle plate	Johnson & Johnson
Suture needle	Johnson & Johnson	Vcp397H
Syringe	Johnson & Johnson
syringe needle	Johnson & Johnson
tissue forceps	Johnson & Johnson
trocar(XCEL)	Ethicon Endo-Surgery	695C71
Ultrasonic knife spacers	Johnson & Johnson
ultrasound knife	Johnson & Johnson
yarn ball	Johnson & Johnson