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Laparoscopic Left Pancreatosplenectomy

  • Laparoscopy
  • Pancreas is section at the isthmus
  • Admission the day before surgery
  • No bowel preparation required
  • Operating time 3 hours
  • No nasogastric tube required
  • Left-side drainage
  • Length of hospital stay 15 days on average
Cystic tumours of the pancreas can be of different nature. They are, in order of frequency :

- Mucinous cystadenomas and cystadenocarcinomas (these call for systematic surgical in-dication)
- Serous cystadenomas (usually no surgical indication)
- IPMN (Intraductal Papillary Mucinous Neoplasms): when the cyst is small, therapeutic abstention is required because the risk of transformation into cancer is very low. When it is greater than 3 cm, surgical resection of the tumour is recommended.
- Cystic endocrine tumours (surgical resection is necessary and these tumours have good prognosis)
- Pseudopapillary and solid tumours (surgical indication is systematic)

These tumors must be differentiated from "pseudocysts" which are always benign and do not require surgery in the majority of cases. In case of discovery of a cyst in the pancreas (most often fortuitous), additional examina-tions to be carried out are (except for endocrine tumours which require more specialised com-plementary examinations) :

- Abdominopelvic scan
- MRI of the pancreas when there is still doubt following the scan
- Most often, a gastroscopy performed by a specialised gastroenterologist, who will also perform a cyst biopsy to analyse the nature of the cyst under a microscope.

These cystic tumours are often located on the body or the tail of the pancreas. If the tu-mour is benign, a simple enucleation under laparoscopy is possible. The surgery consists in removing only the tumour while preserving the rest of the pancreatic gland. When the tumour is benign but large, a spleen-preserving caudal or corporeo-caudal pancreatectomy is still pos-sible under laparoscopy. When cancer is confirmed, it is necessary to consider a left pancrea-tosplenectomy (removal of the body and the tail of the pancreas with the spleen). This surgery is also performed under laparoscopy. For these 3 surgeries, the 2 complication risks are :

- Pancreatic fistula (which usually does not require surgical revision)
- Hemorrhage that requires re-intervention to aspirate the blood clot.

Whatever the case, when a cystic tumour of the pancreas is diagnosed, the therapeutic at-titude to adopt (surveillance or surgery) will always be validated in consultation with radiolo-gists, gastroenterologists and oncologists.