Pancreatic injuries during laparoscopic urologic surgery.
OBJECTIVE
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.
Varkarakis
Ioannis M
IM
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-8915, USA.
Allaf
Mohamad E
ME
Bhayani
Sam B
SB
Inagaki
Takeshi
T
Su
Li M
LM
Kavoussi
Louis R
LR
Jarrett
Thomas W
TW
D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects*; D010179:Pancreas / Q000293:injuries*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*