Pancreatic cystic neoplasm Flashcards
(6 cards)
Overview of Pancreatic cystic neoplasm Mx
WHO classification of pancreatic cystic neoplasm
Classification based on ductal communication
Overview of Pancreatic cytic neoplasm types
Overview of IPMN
Distal pancreatectomy for pancreatic cyst
How to perform distal pancreatectomy due to pancreatic tail cystic neoplasm?
-consent - complication POPF
-preserving the spleen if possible
-antibiotic
-RT
-vaccination - potential risk of splenectomy
Abdominal opening, no need details open in layers until I breach the peritoneum
Midline incision? Any other idea incision? Left subcostal reverse Makuuchi?
depend on the size
Do a full ex laparotomy, for liver mets or peritoneum mets
-especially the omentum in this case
-LN at the celiac trunk
(Any present of the lesion, take the mets biopsy and deemed non resectable and palliate)
Assess the resectability, what do you mean?
-celiac trunk LN, adjacent organ
Mobilised the stomach through the lesser sac
In order for the safe lesser sac
-avascular plane of the gastrocolic ligament, just above the transverse colon, usually at the mid colon going towards left lateral
While reaching the spleen, dissection will go towards the hilum of the spleen
Approaching the hilum there will be a left gastroepiploic artery identification and required ligation transection
-then I will aspect to reach the spleenic hilum
Splenocolic ligament, will identified the short gastric ligament
-then splenorenal ligament then I will be able to push the stomach away
-then only I can assess the pancreatic mass
Mass resectable
-isolate splenic artery usually located at the sup border of the pancreas
-skeletonized and applied vessel loop
-then will be pancreatic mobilisation
Can be medial or lateral mobilisation first
In a case of ca preferably medial first approached to prevent splenic vein thrombosis from the tumor to shift proximal
Decide on the margin and border to resect
Dissection start from inferior border of the pancreas
-retropancreatic area to identified the splenic vein
-then loop the splenic vein
-continue dissection laterally
If performing splenectomy start from lateral
-ligate the splenic artery first, ligate and transfixed (proline 3/0), silk tie on the ligated knot
-second option, haemolock
-then only secret the vein
Pancreatic lesion need to clear up to gerota fascia
If stapler the pancreas wat else need to be done
-using a nonabsorable suture, running through using mattress suture for haemostat and duct closure
Post op
-drain and RT
How to manage the drain
Definition of pancreatic fistula?
