Laparoscopic vs Open Distal Pancreatectomy

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Abstract
With the advances in instrument and video technology, laparoscopic approaches have gained favor in many procedures and across most surgical disciplines. These approaches have demonstrated advantages over open approaches with regard to blood loss, operative time, pain, wound morbidity, and length of hospital stay in several procedures. In addition to cholecystectomy, herniorrhaphy, colectomy, and bariatric procedures, many advantages are also suggested in solid organ resection such as that of the liver and spleen.1,2 Laparoscopic pancreatic resection has been approached more cautiously and with less enthusiasm because of the retroperitoneal location, proximity to major vasculature, and propensity for postoperative complications. Despite the apprehensive use and acceptance of laparoscopic distal pancreatectomy (LDP), several case series and comparative cohort studies have suggested that laparoscopic approaches to distal pancreatic resection provide similar advantages that have been demonstrated for other minimally invasive procedures.3-5 However, limitations of selection bias, small sample size, and pooling of multi-institutional data have prevented a meaningful comparative trial of LDP and open distal pancreatectomy (ODP).6-9 We report a large, single-institutional, comparative study of these 2 approaches within a case-matched cohort design, attempting to better elucidate the benefits of laparoscopy.