Laparoscopic treatment of pancreatic disorders: diagnosis and staging, palliation of cancer and treatment of pancreatic pseudocysts

Abstract

After the spread of laparoscopic cholecystectomy, minimally invasive surgery has been applied to other organs such as the pancreas. Diagnostic laparoscopy is a very useful tool which provides information in conjunction with other instruments such as ultrasonography and computed tomography in the study of pancreatic cancer. Laparoscopic ultrasonography improves the sensibility and specificity of laparoscopy alone in predicting resectability. Although experimental cases of pancreatic resection have been described, the majority of patients require palliative treatment. Surgical bypass has a high morbidity rate and nonoperative biliary decompression has become an established treatment for relieving jaundice. However, these techniques are associated with a high rate of recurrent obstruction. Laparoscopic cholecystojejunostomy gives the advantage of definitive bypass with shorter hospital stay, and a gastrojejunostomy can also be performed when duodenal obstruction occurs. Relief of pain is possible with a thoracoscopic splanchnicectomy, which offers good results. Internal drainage for pseudocysts is another new application of laparoscopic surgery which gives excellent results.