Pancreatic injuries during laparoscopic urologic surgery
Ioannis M Varkarakis1, Mohamad E Allaf, Sam B Bhayani
1James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-8915, USA.
Objectives:
To review our experience with pancreatic injury (PI) associated with urologic laparoscopy. PI associated with urologic laparoscopy is uncommon.
Methods:
From January 1999 to April 2004, 890 laparoscopic operations for upper urinary tract pathologic findings were performed, of which 574 were left-sided procedures. We reviewed the medical records for recognized intraoperative or postoperatively documented PI and recorded the patient demographic data and intraoperative and postoperative management.
Results:
Four PIs were identified, all associated with left-sided procedures. The overall rate of PI was 0.44%. Two injuries occurred during left radical nephrectomy (2.1%) and two during left adrenalectomy (8.6%). The mean tumor size was 6 +/- 3.4 cm. The diagnosis was made intraoperatively in 1 patient, postoperative midepigastric pain with elevated serum amylase levels was the clinical presentation in 2 patients, and the incidental finding of pancreatic tissue in the final pathologic specimen confirmed the injury in the fourth patient. A prolonged pancreatic fistula developed only in 1 case. Three patients were treated conservatively and computed tomography-guided drainage of a pancreatic collection was required in one. The mean hospital stay was 18 days (range 4 to 57).
Conclusions:
PI is uncommon but can result in significant morbidity. Intraoperative detection and repair can minimize sequelae. Management with conservative measures and percutaneous drainage is usually successful, although a prolonged postoperative course can be expected.
