Is there a place for laparoscopic reoperation for complications after minimally invasive pancreatectomy?

Abstract

Introduction: Although the use of the minimally invasive approach is expanding in pancreatic surgery, indications and results of laparoscopic reinterventions after pancreatectomy are unknown.

Methods: Based on the multicenter AFC (Association Française de Chirurgie) cohort (2010-2021), patients who underwent open (open reoperation group) or laparoscopic (laparoscopic reoperation group) reoperation within 90 days after minimally invasive pancreatectomy were included and compared. Inverse probability of treatment weighting analysis was performed to determine the impact of laparoscopic reoperation on postoperative mortality.

Results: Of the 3,412 patients who underwent minimally invasive pancreatectomy, 298 (8.7%) underwent reoperation, with a median delay of 9 days (interquartile range: 4-19 days). Most frequent causes of reintervention were pancreatic fistula with uncontrolled sepsis (postoperative pancreatic fistula) (23%) and hemorrhage (postpancreatectomy hemorrhage) (46%). Sixty-five patients (22%) underwent laparoscopic and 233 (78%) open reoperation. Laparoscopic reoperation was mostly performed for postoperative pancreatic fistula drainage (43%), postpancreatectomy hemorrhage (26%), bowel obstruction (20%), or peritonitis (8%). Patients in the laparoscopic reoperation group were more often reoperated on after distal pancreatectomy (54% vs 36% in open reoperation group, P = .017). After pancreatoduodenectomy, laparoscopic reoperation was more often performed for bowel obstruction compared with open reoperation (20% vs 4%, P = .005). After reintervention, the postoperative mortality rate was 13%. Hospital stay was significantly shorter after laparoscopic reoperation (28 vs 36 days, P = .037). After adjustment for inverse probability of treatment weighting, laparoscopic revision was statistically associated with less postoperative mortality (odds ratio = 0.81, 95% confidence interval: 0.81-0.95).

Conclusion: The laparoscopic approach may be an option for surgical reintervention after minimal invasive pancreatectomy in non-life-threatening indications, mainly after distal pancreatectomy for postoperative pancreatic fistula drainage or after pancreatoduodenectomy for occlusion.