Proceedings on Minimally Invasive Surgery
Vol 1 No 1 (2019): Proc MIC

Free Abstracts, ID 223

Minimally invasive interventions on the pancreas: early recovery program use

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M. I. Tsarev (Russian National Research Medical University named Pirogov, Moscow Clinical Hospital 1 named Pirogov, Moscow, Russia), A. V. Sazhin (Russian National Research Medical University named Pirogov, Moscow Clinical Hospital 1 named Pirogov, Moscow, Russia), K. D. Dalgatov (Russian National Research Medical University named Pirogov, Moscow Clinical Hospital 1 named Pirogov, Moscow, Russia), A. O. Kurskov (Russian National Research Medical University named Pirogov, Moscow Clinical Hospital 1 named Pirogov, Moscow, Russia), M. V. Kozodaeva (Russian National Research Medical University named Pirogov, Moscow Clinical Hospital 1 named Pirogov, Moscow, Russia)

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Abstract

Introduction: Implementation of early recovery program in combination with minimally invasive technique can provide better results.


Materials and Methods: In the department of surgery, on the basis of GKB №1 named by Pirogov N.I. In the period from 2016 to 2017, 32 laparoscopic operations on the pancreas were performed. 12 laparoscopic pancreaticoduodenectomy for malignant neoplasms, 16 laparoscopic distal resections, 2 laparoscopic enucleation of insulinoma, 2 Frey resection. In the perioperative period, patients who underwent laparoscopic Whipple procedure were performed in accordance with Fast Track protocol. The main components of the preoperative preparation are: prevention of thromboembolic complications - low molecular weight heparin in prophylactic doses, liquid carbohydrate mixtures with low glycemic index are allowed 2 hours before the operation, refusal of mechanical bowel preparation. Intraoperative: epidural analgesia, goal directed infusion therapy, one Jackson-Pratt drainage, refusal of prolonged artificial ventilation. In the postoperative period: the day after the operation patient is transferred to the surgical department, the urinary catheter is removed, multimodal analgesia, early activation, enteral feeding with liquid protein-carbohydrate mixtures. On the third day all patients undergo computer tomography with intravenous and oral contrast, the drainage is removed - with an amylase level less than 200 U / l. Solid food is allowed. The intensity of the pain is monitored on the 3rd day and on the 5th day after the removal of the epidural catheter on a visually analog scale. On the 5th day, the overall pshyco-emotional state of the patients is assessed according to the quality of life questionnaires EORTC and GSRS. Clavien-Dindo I - 3 patients, Clavien-Dindo II in 2 patients. One patient died from sepsis. The average bed-day was 8-9 days. Two patients after distal resection for cystic mucinous neoplasia developed pancreatic fistula type B. The average bed-day was 10-11 days.


Conclusions: The use of laparoscopic methods in combination with Fast Track protocol can give promising results.

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