Laparoscopic surgery of the pancreas.

Diagnostic laparoscopy provides useful information in patients with pancreatic disease and is the most reliable technique for the staging of patients with pancreatic cancer. The advent of laparoscopic contact ultrasonography has enhanced the diagnostic and staging potential of laparoscopy. In addition to laparoscopic cholecystectomy for acute gallstone-associated pancreatitis, the following operations have been performed laparoscopically: bilio-enteric bypass and gastrojejunostomy in patients with advanced pancreatic cancer; internal drainage for pseudocysts; resection of insulinomas; distal resection for chronic pancreatitis; and pancreaticoduodenectomy for pancreatic cancer. Aside from cholecystectomy, there is as yet, insufficient information to conclude on the advantages of these laparoscopic approaches although the early results, particularly in the palliation of patients with malignant jaundice, are promising. Bilateral thoracoscopic splanchnicectomy for the relief of intractable pancreatic pain is also under current evaluation.