Laparoscopic Transection of the Pancreatic Neck With Enucleation of Intraductal Papillary Mucinous Neoplasm (IPMN) in the Uncinate Process and Pancreatic Reconstruction.

BACKGROUND

Laparoscopic transection of the pancreatic neck with enucleation of intraductal papillary mucinous neoplasm (IPMN) in the uncinate process and pancreatic reconstruction represents a novel surgical approach for managing pancreatic intraductal papillary mucinous neoplasms. This technique may provide a new therapeutic option for patients with benign or low-grade malignant tumors in the pancreatic uncinate process. This study aimed to assess this procedure's short- and long-term clinical outcomes and delineate its technical operative details.

METHODS

For a 42-year-old man, branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) was diagnosed. Abdominal contrast-enhanced computed tomography (CT) showed an irregular cystic lesion in the cephalad portion of the pancreatic uncinate process, with no enhancement on post-contrast imaging. Abdominal MRI demonstrated the irregular cystic lesion (38 × 18 mm), showing suspected communication with the pancreatic duct. Endoscopic ultrasound (EUS) showed a multicystic lesion in the pancreatic uncinate process measuring up to 40 mm in maximum diameter, with heterogeneous wall thickness and well-defined margins. The patient subsequently underwent laparoscopic transection of the pancreatic neck with enucleation of IPMN in the uncinate process and pancreatic reconstruction.

RESULTS

The patient experienced a biochemical leak postoperatively, with a daily drainage volume of approximately 20 mL. The drainage volume gradually decreased, and the drain was removed on postoperative day 10, followed by hospital discharge. At this writing, follow-up evaluations have shown no complications such as steatorrhea, secondary diabetes, or dyspepsia. A contrast-enhanced CT scan of the entire abdomen showed no abnormalities. Morphologic and immunohistochemical analyses confirmed the diagnosis of IPMN with mild epithelial dysplasia.

CONCLUSION

Laparoscopic transection of the pancreatic neck with enucleation of IPMN in the uncinate process and pancreatic reconstruction represents a safe and effective surgical approach for managing pancreatic uncinate process IPMN.