Outcomes of Laparoscopic Pancreaticoduodenectomies in a Low – to – Middle-income Country: A Retrospective Cohort Study from South Africa

Background: This is the first study to examine the feasibility and outcomes of laparoscopic pancreaticoduodenectomy in South Africa. Overall, laparoscopic pancreaticoduodenectomy remains an uncommon international procedure. Materials and Methods: This was a retrospective review of a prospectively maintained database. Preoperative, intraoperative, and postoperative data were collected and analysed. Postoperative data regarding morbidity, especially postoperative pancreatic fistula and mortality. Long-term follow-up data were also collected. The database was searched for patients who underwent pancreaticoduodenectomy from 01 January 2018 to December 31, 2024. Results: A total of 127 whipple procedures were performed during the study period. One hundred and fourteen patients underwent laparoscopic surgery and were analyzed further. Tumor-free margins (R0) were achieved in 110 (96,4%). The mean blood loss was 213 ml (105-353), and the median operative time was 390 minutes (289-603). The postoperative morbidity rate was 35,9%. Grade B/C postoperative pancreatic fistulas occurred in 21 patients (18,4%). The pathological diagnoses in the series included malignant and benign cases; malignancy rate was 86,6%. Our results showed that a smaller pancreatic duct size (5–10 mm, p=0.035; <5 mm, p=0.022) and bile duct size (p=0.011) were significantly associated with an increased risk of pancreatic fistula. Clavien-Dindo grade 3/4 complications occurred in 9 (7,8%) patients. Postoperative mortality rates were low, with 2.6% (n=3) 30 day and 4.4% (n=5) at 90 days. Conclusion: Laparoscopic pancreaticoduodenectomy is feasible and safe in low-to middle-income countries. The surgical results are comparable to those published in international series, providing an adequately trained team.