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Laparoscopic Distal Pancreatectomy for Traumatic Transection
Part of
Blunt Abdominal Trauma 3 items
Chapter 1 of 4 · Case-Based Learning
Case presentation
Introduction and Case Presentation
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What the experts said
Resection versus non-operative management for traumatic pancreatic transection is still somewhat controversial.
The pediatric surgery service strongly prefers an early distal pancreatectomy in cases of transection.
Distal pancreatectomy for traumatic transection was typically done through a laparotomy.
This video demonstrates the first laparoscopic distal pancreatectomy for trauma performed by this service.
The patient was hemodynamically stable at presentation but had significant epigastric pain and tenderness.
Pancreatic enzymes were elevated in this patient.
CT scan showed a clear pancreatic transection at a point to the left of the spine.
The patient underwent the operation approximately 10 hours after admission.
A 3-trochar approach was used: a 12 millimeter trochar at the umbilicus for camera, stapler, and specimen extraction, and two 5 millimeter upper abdominal trochars for grasping and dissection.
A large curved needle is brought through the abdominal wall, takes a large bite of stomach, and exits the abdominal wall again more medially, then tied outside to keep the stomach retracted anteriorly.
The field at the site of pancreatic transection was remarkably clean.
The pancreas was only holding by a thin superior bridge of tissue at the transection site.
The transection was completed with the sealing device.
A rec gauze was left at the site of transection to soak up any oozing that results during the remainder of the dissection.
The LigaSure serves as an excellent dissecting device, minimizing instrument exchange.
Each venous tributary to the pancreas was well skeletonized prior to ligation and division.
The inferior pole of the spleen was ischemic, but this had no clinical consequences.
The proximal pancreas was further mobilized for approximately 1 centimeter to allow for closure of the pancreatic duct using a vascular stapler.
A Jackson Pratt drain was placed in the pancreatic bed, and fibrin sealant was injected over the staple line.
The patient was fed on the 2nd postoperative day.
The drain was removed on the 4th postoperative day.
The patient was discharged home on the 5th postoperative day.
Follow up at one year continued to show an excellent outcome.