title: Inferoposterior duodenal approach for laparoscopic pancreaticoduodenectomy.
abstract: OBJECTIVE
  To investigate the advantages of inferoposterior duodenal approach (IPDA) for laparoscopic pancreaticoduodenectomy (LPD).
  
  
  METHODS
  A total of 36 patients subjected to LPD were admitted to the Affiliated Yijishan Hospital of Wannan Medical College from December 2009 to February 2015. These patients were diagnosed with an ampullary tumour or a pancreatic head tumour through computed tomography, magnetic resonance imaging or endoscopic retrograde cholangiopancreatography preoperatively. The cases were selected on the basis of the following criteria: tumour diameter < 4 cm; no signs of peripheral vascular invasion; evident lymph node swelling; and distant metastasis. Of the 36 cases, 20 were subjected to anterior approach (AA; AA group) and 16 were subjected to IPDA (IPDA group). Specimen removal time, intraoperative blood loss and postoperative complications in the two groups were observed, and their differences were compared.
  
  
  RESULTS
  During the operation, 2 cases in the AA group and 2 cases in the IPDA group were converted to laparotomy; these cases were excluded from statistical analysis. The remaining 32 cases successfully completed the surgery. The AA group and IPDA group exhibited the specimen removal time of 205 ± 52 and 160 ± 35 min, respectively, and the difference was significant (P < 0.01). The AA group and IPDA group revealed the intraoperative blood loss of 360 ± 210 mL and 310 ± 180 mL, respectively, but these values were not significantly different. Postoperative pathological results revealed 4 cases of inferior common bile duct cancer, 8 cases of duodenal papillary cancer, 6 cases of ampullary cancer, 13 cases of pancreatic cancer, 3 cases of chronic pancreatitis accompanied with cyst formation or duct expansion, and 2 cases of mucinous cystic tumour in the pancreatic head. The postoperative complications were pulmonary Staphylococcus aureus infection, incision faulty union, ascites induced poor drainage accompanied with infection, bile leakage, pancreatic leakage and delayed abdominal bleeding.
  
  
  CONCLUSIONS
  In IPDA, probing for important steps can be performed in early stages, surgical procedures can be optimised and operation time can be shortened.
authors.affiliation: Xiao-Ming Wang, Wei-Dong Sun, Ming-Hua Hu, Gua-Nan Wang, Ya-Qi Jiang, Xiao-San Fang, Meng Han, Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui Province, China.
authors.forename: Xiao-Ming
authors.initials: XM
authors.lastname: Wang
authors.affiliation: Xiao-Ming Wang, Wei-Dong Sun, Ming-Hua Hu, Gua-Nan Wang, Ya-Qi Jiang, Xiao-San Fang, Meng Han, Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui Province, China.
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Sun
authors.affiliation: Xiao-Ming Wang, Wei-Dong Sun, Ming-Hua Hu, Gua-Nan Wang, Ya-Qi Jiang, Xiao-San Fang, Meng Han, Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui Province, China.
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Hu
authors.affiliation: Xiao-Ming Wang, Wei-Dong Sun, Ming-Hua Hu, Gua-Nan Wang, Ya-Qi Jiang, Xiao-San Fang, Meng Han, Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui Province, China.
authors.forename: Gua-Nan
authors.initials: GN
authors.lastname: Wang
authors.affiliation: Xiao-Ming Wang, Wei-Dong Sun, Ming-Hua Hu, Gua-Nan Wang, Ya-Qi Jiang, Xiao-San Fang, Meng Han, Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui Province, China.
authors.forename: Ya-Qi
authors.initials: YQ
authors.lastname: Jiang
authors.affiliation: Xiao-Ming Wang, Wei-Dong Sun, Ming-Hua Hu, Gua-Nan Wang, Ya-Qi Jiang, Xiao-San Fang, Meng Han, Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui Province, China.
authors.forename: Xiao-San
authors.initials: XS
authors.lastname: Fang
authors.affiliation: Xiao-Ming Wang, Wei-Dong Sun, Ming-Hua Hu, Gua-Nan Wang, Ya-Qi Jiang, Xiao-San Fang, Meng Han, Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui Province, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016063:Blood Loss, Surgical; D002681:China; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004386:Duodenum / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Laparoscopic pancreaticoduodenectomy; Surgical approach