Although many reports have described laparoscopic pancreatic surgery,
laparoscopic pancreaticoduodenectomy (PD) has not been widely employed because of
technical difficulties. This paper describes a totally laparoscopic
pylorus-preserving PD performed for an intraductal papillary-mucinous neoplasm.
After the laparoscopic resection, an end-to-side pancreaticojejunostomy including
duct-to-mucosa anastomosis without a stenting tube, an approximation of the pancreas
stump and jejunal wall, an end-to-side hepaticojejunostomy, and an end-to-side
duodenojejunostomy were performed intracorporeally. The patient recovered without
any complications and was discharged on the 14th postoperative day. The surgical
margin was free of neoplastic changes. Although the experience is limited and the
appropriate indications must await future studies, this case indicates that a
laparoscopic pylorus-preserving PD can be feasible, safe, and effective in highly
selected patients.