Diagnosis and treatment of pancreas divisum: A literature review

Background:Pancreas divisum is a congenital embryological disease caused by a lack of fusion between the ventral and dorsal pancreatic ducts in the early stages of embryogenesis.Recurrent acute pancreatitis,chronic pancreatitis or chronic abdominal pain are the main clinical syndromes at presentation and occur in only 5%of the patients with pancreas divisum.This review aimed to discuss diagnosis and treatment strategies in patients with symptomatic pancreas divisum.Data sources:We report a literature review from 1990 up to January 2018 to explore the various diagnostic modalities and surgical techniques and results reported in the surgical treatment of pancreas divisum.Results:There are limited reports available on this topic in the literature.We analyzed and described the main indications in the treatment of pancreas divisum,focusing on surgical treatment and a discussion of the different approaches.Furthermore,we report the results from our experience in two cases of pancreas divisum treated by pancreatic head resection with segmental duodenectomy(the Nakao procedure).Conclusions:Pancreas divisum is a common pancreatic malformation in which only a few patients develop a symptomatic disease.Surgical treatment is needed in case of endoscopic drainage failure and in cases complicated with chronic pancreatitis and local complications.Many techniques,of greater or lesser complexity,have been proposed.

Role of robotic-assisted pancreatic surgery:lessons learned from our initial experience

BACKGROUND:Minimally invasive surgery has achieved worldwide acceptance in various fields, however, pancreatic surgery remains one of the most challenging abdominal procedures. In fact, the indication for robotic surgery in pancreatic disease has been controversial. The present study aimed to assess the safety and feasibility of robotic pancreatic resection.METHODS:We retrospectively reviewed our experience of robotic pancreatic resection done in Sanchinarro University Hospital. Clinicopathologic characteristics, and perioperative and postoperative outcomes were recorded and analyzed.RESULTS:From October 2010 to April 2016, 50 patients underwent robotic-assisted surgery for different pancreatic pathologies. All procedures were performed using the da Vinci robotic system. Of the 50 patients, 26 were male and 24 female. The average age of all patients was 62 years. Operative time was 370 minutes. Among the procedures performed were 16 pancreaticoduodenectomies(PD), 23 distal pancreatectomies(DP), 11 tumor enucleations(TE). The mean hospital stay was 17.6 days in PD group, 9.0 days in DP group and 8.4 days in TE group. Pancreatic fistula occurred in 10 cases(20%), 2 after PD, 3 after DP, and 5 after TE. Four patients had postoperative transfusion in PD group and one in DP group. Conversion to open laparotomy occurred in four patients(8%). No serious intraoperative complications were observed. CONCLUSIONS:From our early experience, robotic pancreatic surgery is a safe and feasible procedure. Further experience and follow-up are required to confirm the role of robotic approach in pancreatic surgery.

The issue of the cost of robotic distal pancreatectomies

Robotic approach is already a new technological system in surgery and its potential advantages such as ergonomics,reduced tremor,3D view and improved instruments movements have been well described(1,2).Concerning the current literature,the studies addressing the robotic benefits on left pancreatectomies are few.However,it has been showed that robotic distal pancreatectomy is both feasible and safe as well as the laparoscopic and the standard open approach.Although,there is a lack of high-level economic studies comparing these techniques(3-6).