Young woman with a small insulinoma of pancreas tail. She presents no comorbities and underwent ten years ago to the OPEN Fobi-Capela Procedure (ROUX - Y gastric BYPASS) FOR OBESITY TREATMENT. Nowadays, We have performed 70 cases of laparoscopic distal pancreatectomy and we have two open convertions. Two of them were patients which previously underwent a gastric bypass. The insulinoma is posterior position and we have not seen this lesion at MRI, but at octreoscan images it seems close to the as splenic vein as wirsung duct. Up-Front Open or laparoscopic approach? Enucleation or Distal Pancreatectomy with spleen preservation? Intraoperative US is absolutely necessary on this case? Because we have only usio probe for open approach, once choose a enucleation we should perform it by means of open approach.
I believe that a laparoscopic distal pancreatectomy with spleen preservation is the best technique. There is no point performing enucleation because the tumor is really in the distal tail of the pancreas. You will spare only 2 cm with enucleation and the tumor is central located that may pose a risk of duct injury with this technique.
Thanks Professor Marcel - Would you prefer Warshaw s or Kimura s Approach for LDP in this specific case?
Kimura approach. Warshaw may fail sometimes with some degree of splenic infarct. Usually this infarct is asymptomatic but sometimes a splenectomy may be required later on.