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 analyzed. Postoperative data regarding morbidity, and mortality were analysed. Long-term follow-up data were also collected. The database was searched for patients who underwent pancreaticoduodenectomy from 1 January 2018 to 31 December 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 min (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; the 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 nine (7.8%) patients. Postoperative mortality rates were low, with 2.6% ( n = 3) at 30 days 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, provided that an adequately trained team is present.