title: Laparoscopic Pylorus- and Spleen-Preserving Duodenopancreatectomy for a Multifocal Neuroendocrine Tumor.
abstract: BACKGROUND
  In contrast to laparoscopic left pancreatic resection, laparoscopic total duodenopancreatectomy is a procedure that has not been standardized until now. It is not only the complexity that limits such a procedure but also its rare indication. The following article demonstrates the technical aspects of laparoscopic pylorus- and spleen-preserving duodenopancreatectomy.
  
  
  METHODS
  The indication for intervention in the underlying case was a patient diagnosed with a multiple endocrine neoplasia (MEN) I syndrome and a multifocal neuroendocrine tumor (NET) infiltrating the duodenum and the pancreas. The patient was post median laparotomy which was necessary after jejunal perforation due to a peptic ulcer. The resection was carried out entirely laparoscopically, and the reconstruction, which included a biliodigestive anastomosis and a gastroenterostomy, was carried out by means of a median upper abdomen laparotomy of 7 cm in length through which the resected specimen was also removed. The total operative time was 391 min. The blood loss accounted for 250 ml. The postoperative course was uneventful, and the patient was discharged on the eighth postoperative day.
  
  
  CONCLUSIONS
  Laparoscopic pancreatectomy is a treatment option in carefully selected indications. The complexity of the operation demands a high level of expertise in the surgical team.
authors.affiliation: Visceral, Thoracic and Vascular Surgery, West Coast Hospital Heide, Heide, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Schlöricke
authors.affiliation: Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Hoffmann
authors.affiliation: Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kujath
authors.affiliation: Institute of Diagnostic and Interventional Radiology, West Coast Hospital Heide, Heide, Germany.
authors.forename: Ganesh M
authors.initials: GM
authors.lastname: Shetty
authors.affiliation: Institute of Diagnostic and Interventional Radiology, West Coast Hospital Heide, Heide, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Scheer
authors.affiliation: Visceral, Thoracic and Vascular Surgery, West Coast Hospital Heide, Heide, Germany.
authors.forename: Marc O
authors.initials: MO
authors.lastname: Liedke
authors.affiliation: Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Zimmermann
keywords: Laparoscopic total duodenopancreatectomy, LDP; Multiple endocrine neoplasia, MEN; Neuroendocrine tumor, NET; Pylorus- and spleen-preserving duodenopancreatectomy