title: Laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a UK experience and a systematic review of the literature.
abstract: BACKGROUND
  Advances in operative techniques and technology have facilitated laparoscopic distal pancreatectomy (LDP) and laparoscopic pancreaticoduodenectomy (LPD).
  
  
  METHODS
  All distal pancreatectomies were attempted laparoscopically, while selected patients underwent LPD. The literature was systematically reviewed.
  
  
  RESULTS
  Between 2002 and 2008, 21 patients underwent LDP (n=14) or LPD (n = 7). The mean operating time, blood loss, and hospital stay after LDP were 265 min, 262 ml, and 7.7 days, respectively, and after LPD they were 628 min, 350 ml, and 11.1 days, respectively. The conversion, morbidity, pancreatic fistula, readmission, reoperation, and mortality after LDP were 7.1, 35.7, 28.4, 28.4, 0, and 7.1% respectively, and after LPD they were 0, 28.6, 14.3, 28.6, 0, and 0% respectively. The literature review identified 987 LDP and 126 LPD. Most LDP were for benign disease (83.9%) while most LPD were for malignancy (91.5%). The mean operating time, morbidity, pancreatic fistula, mortality, and hospital stay after LDP were 221.5 min, 24.7%, 16.4%, 0.4%, and 7.7 days, respectively, and after LPD they were 448.3 min, 28.6%, 11.6%, 2.1%, and 16 days, respectively.
  
  
  CONCLUSIONS
  LDP, particularly for benign disease and low-grade malignancy, is increasingly becoming the gold standard approach in experienced hands. In selected patients, LPD is feasible and safe. Long-term follow-up data are needed.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, North Manchester General Hospital, and The University of Manchester, Delaunays Road, Manchester, UK. Bammori@btinternet.com
authors.forename: Basil J
authors.initials: BJ
authors.lastname: Ammori
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Ayiomamitis
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D013997:Time Factors; D006113:United Kingdom