Laparoscopic total remnant pancreatectomy after laparoscopic pancreaticoduodenectomy

Total remnant pancreatectomy after pancreaticoduodenectomy (PD) is a difficult procedure. Recently, distal pancreatectomy and PD have been performed laparoscopically. Herein, we present the first case report of a laparoscopic total remnant pancreatectomy. A 72-year-old woman underwent a totally laparoscopic pylorus-preserving PD for inferior bile duct cancer. The tumor was composed of moderately differentiated tubular adenocarcinoma and was diagnosed as pStage III according to the UICC-TNM classification. Eighteen months later, CT showed a low-density mass in the remnant pancreas. We conducted a total resection of the remnant pancreas laparoscopically. Histologically, it was diagnosed as a primary pancreatic cancer. The patient's postoperative course was uneventful. She was discharged on postoperative day 14. When an initial PD is performed laparoscopically, laparoscopic total remnant pancreatectomy is technically feasible and safe in selected patients.