JOP. J Pancreas (Online) 2009 May 18; 10(3):328-331. JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 10, No. 3 - May 2009. [ISSN 1590-8577] 328 CASE REPORT Total Pancreatectomy: Doing It with a Mini-Invasive Approach Riccardo Casadei, Giovanni Marchegiani, Marco Laterza, Claudio Ricci, Nicola Marrano, Alessandra Margiotta, Francesco Minni Department of Surgical and Anesthesiological Sciences, “Alma Mater Studiorum” University of Bologna, “S. Orsola-Malpighi” Hospital. Bologna, Italy ABSTRACT Objective Pancreatic laparoscopic surgery represents one of the most discussed and demanding fields in surgery. Total pancreatectomy is considered to a viable option for treating both benign and malignant pathologies of the pancreas and, thanks to the introduction of laparoscopic techniques for pancreatic resections into clinical practice, it can be performed nowadays with a less invasive approach. Case report We report the case of a combined total pancreatectomy, consisting of a totally laparoscopic body- tail mobilization followed by the opening of a right subcostal mini-laparotomy in order to perform a pancreaticoduodenectomy and a reconstructive phase. Discussion This technique represents the result of experience acquired in the last decade in the field of advanced laparoscopic pancreatic surgery. It consists of a widely accepted laparoscopic splenopancreatectomy and of a traditional pancreaticoduodenectomy which nowadays is considered safer and less time-consuming than the experimental laparoscopic one. INTRODUCTION The first total pancreatectomy was reported in 1943 by Rockey who performed the procedure for a carcinoma [1]. At the beginning, it was not recommended and was even abandoned by most surgeons because of high peri- and post-operative morbidity and mortality. The incidence of postoperative diabetes control problems ranged from 15 to 75% and, according to several studies was the cause of death in the long-term in nearly half of all patients [2]. In recent decades, however, total pancreatectomy has become a satisfactory treatment option [3, 4] in selected cases since notable improvements in both surgery and postoperative management have been achieved. Improvements in surgical techniques have allowed an “organ preserving” total pancreatectomy, preserving such organs as the pylorus and the spleen. Moreover the introduction of laparoscopic techniques for pancreatic resections into clinical practice permits a less invasive total pancreatectomy. We herein report a case of a total pancreatectomy in which the laparoscopic technique was combined with the open approach to allow a mini-invasive approach. CASE REPORT A 75-year-old man was admitted to our institute for abdominal pain, weight loss and greasy stools. His past medical history was characterized by a previous episode of acute pancreatitis and he was affected by arterial hypertension, type II diabetes, ischemic heart disease and chronic obstructive pulmonary disease. The patient had previously undergone a right-superior lobectomy for a benign tumor, and surgery for lithiasis of the right kidney. Laboratory tests showed a slight increase of serum amylase level (112 U/L; reference Received February 24 th , 2009 - Accepted April 1 st , 2009 Key words Laparoscopy; Pancreas; Surgery Abbreviations ASA: American Society Anesthesiologists Correspondence Riccardo Casadei Dipartimento di Scienze Chirurgiche e Anestesiologiche, Chirurgia Generale-Minni, Alma Mater Studiorum-Università di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138 Bologna, Italy Phone: +39-051.341.541; Fax: +39-051.341.483 E-mail: riccardo.casadei@aosp.bo.it Document URL http://www.joplink.net/prev/200905/21.html Figure 1. CT scan showing a notable dilatation (>7 mm) of the main pancreatic duct which involved the whole gland.