Comparartive Analysis Of Laparoscopic Versus Open Distal Pancreatectomy

Objective: To investigate the safety and feasibility of laparoscopic distalPancreatectomy(LDP), and evaluate the advantage compared with open distalPancreatectomy(ODP).Methods: We retrospectively analyzed the clinical data of laparoscopic distalPancreatectomy on25cases between June2008and December2011. Among the25patients,9patients were performed operation of laparoscopic distalPancreatectomy with excision of the spleen, the other16patients were performedoperation of laparoscopic distal Pancreatectomy with preservation of the spleen.And during the period, there were42patients undergone open distalPancreatectomy. Among the patients,16patients were performed operation ofopen distal Pancreatectomy with excision of the spleen, the other26patients wereperformed operation of open distal Pancreatectomy with preservation of thespleen. All of patients were divided into LDP group and ODP group. Data ofpatients of two groups were compared, which included:1.generalinformation(gender, age, biochemical indexes, coagulation indexes, et al);2.operation information(intraoperative blood loss, operation time,length ofincision, benign tumor of spleen preserving rate, et al);3.post-operationinformation(anal exsufflation time, biochemical indexes, coagulation indexes,stress indexes, complication, postoperative hospital stay time, hospitalization cost,et al).Results: Two group of patients’ general information(gender, age, biochemicalindexes, coagulation indexes, et al) didn’t have significance difference(P﹥0.05).The coagulation and stress indexes of LDP group went up after the operation, andwent down to the level of preoperative time at the fifth day after operation. Themean of data of LDP group was significantly less than that of ODP group in indexes such as anal exsufflation time, length of incision, postoperative hospitalstay time, complication rate and stress indexes(P﹤0.05). But the cost of operationand the time of excision of laparoscopic distal pancreate was higher than ODPgroup(P﹤0.05). And there were no significant difference of intraoperative bloodloss, biochemical indexes, coagulation indexes, hospitalization cost and pancreaticfistula rate between two groups(P﹥0.05). There were four patients diagnosed ofpancreatic fistula(3A level and1B level) after LDP, and all of the four patientswere cured after conservative treatment. There was no patient dead.Conclusions:1. Laparoscopic distal Pancreatectomy is safe and feasible, but itneeds mastering of the indication of operation.2. Compared to ODP, LDP has theadvantages of minimal injury, earlier recovery and less complication. And it wassuitable to further extension in the clinical.3. LDP is a great difficulty andcomplicated operation, and it needs skilling mastering laparoscopic operationtechniques and the solid surgical anatomy theory.