Short-term Results Of Reoperation Of Laparoscopic And Open Pancreaticoduodenectomy

Objective:To explore the safety,the feasibility and the short-term efficacy of laparoscopic and open pancreaticoduodenectomy in patients undergoing secondary abdominal surgery,and to provide evidence-based evidence for the clinical treatment decisions of patients with a history of abdominal surgery who plan to undergo pancreaticoduodenectomy.Method:Retrospective case-control studies were conducted.According to the inclusion and exclusion criteria,Collected during September 2016 to September 2018 GanDanYi surgical treated by our hospital has a history of abdominal surgery and laparoscopic surgery in our hospital again of pancreaticoduodenal resection(LPD),has a history of abdominal surgery,and surgery in our hospital again open of pancreaticoduodenal resection(OPD)and abdominal surgery for the first time the LPD patients of electronic medical records information,The patients were divided into the laparoscopic group for reoperation(18 cases),the open group for reoperation(14 cases),and the laparoscopic group for the first operation(46 cases).General data of the patients in the three groups were compared,such as age,gender,ALT value,AST value,ca19-9 value,preoperative drainage mode,complications,etc.The operative time,intraoperative bleeding,intraoperative blood transfusion rate,the proportion of ICU patients,postoperative mean hospitalization time,postoperative first feeding time,postoperative total bilirubin decreased value on the third day after surgery,complication grade,average lesion diameter,specimen resection margin,tumor source and so on were collected from the three groups.Results:Intraoperative bleeding was less in the laparoscopic group for reoperation than in the open group for reoperation [(169.44±73.04ml)vs(410.71±200.17ml),P=0.002],the average hospital stay is shorter [(13.94±4.68d)vs(19.07±7.04),P=0.047],postoperative first anal exhaust time is earlier[(4.50±1.15d)vs(6.07±0.73d),P=0.047],the first meal after surgery was earlier[(3.22±0.81d)vs(6.36±2.71d),P=0.008],Similar results were achieved in the laparoscopic group for the first operation.There were no statistically significant differences among the three groups in operation time,intraoperative blood transfusion rate,the proportion of ICU patients admitted,total bilirubin decreased value on the third day after surgery,complication grade,average lesion diameter,specimen cutting edge and tumor origin(P>0.05).Conclusion:In the case of mild to moderate abdominal adhesions,it is safe and feasible to perform LPD in abdominal operation again.The shortterm effect has a relatively minimally invasive advantage.Compared with OPD in abdominal surgery,LPD can reduce intraoperative bleeding,restore gastrointestinal function faster,and reduce postoperative hospital stay.A similar clinical effect of LPD patients in the first abdominal surgery.