Distal Lesions

Staging with laparoscopy is often of benefit with patients with distal pancreatic cancers. If metastatic disease is found, distal pancreatectomy and splenectomy are unlikely to help in the palliation of the patient. Exposure for a distal pan-createctomy and splenectomy can be obtained through a vertical midline incision, or alternatively, a bilateral subcostal incision. The spleen can technically be preserved for benign disease, however, for cancer most groups prefer to remove the spleen en bloc to gain wider margins and incorporate the lymph nodes in the splenic hilum. The spleen is mobilized towards the midline by dividing the lienorenal ligament. The short gastric vessels in the lienogastric ligament are also divided. A plane is then developed behind the pancreatic tail and body, also mobilizing the splenic artery and vein. This dissection is continued several centimeters beyond the tumor. The splenic artery and vein are isolated and suture ligated. The body or tail of the pancreas is then divided after placing a row of overlapping "U" stitches in the remnant. A frozen section is performed on the pancreatic margin to confirm clearance of the lesion and a closed suction drain is generally left in place in case of leak from the pancreatic duct. Several centers are now beginning to use laparoscopic techniques for distal lesions, especially if they have benign characteristics.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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