Minimally invasive interventions on the pancreas: early recovery program use

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.