Imbedding pancreaticojejunostomy used in pure laparoscopic pancreaticoduodenectomy for nondilated pancreatic duct

Surg Endosc. 2017 Apr;31(4):1986-1992. doi: 10.1007/s00464-016-4805-1. Epub 2017 Jan 11.

Abstract

Background: LPD has been cautiously regarded as feasible and safe for resection and reconstruction. However, anastomosis of the remnant pancreas is still thought to be a critical obstacle to the dissemination of LPD in general practice. This study presents a new technique of pancreaticojejunostomy for nondilated pancreatic duct and evaluates its safety and reliability.

Methods: From July 2014 to June 2015, a total of 52 patients underwent LPD with the new technique. A modified technique of duct-to-mucosa PJ was performed with transpancreatic interlocking mattress sutures, named the imbedding duct-to-mucosa PJ. Then the morbidity and mortality was calculated.

Results: This technique was applied in 52 patients after LPD all with nondilated pancreatic duct (1-3 mm). The mean operation time was 4.6 h (range, 3.5-8.3 h) and the median time for the anastomosis was 37 min (range, 24-53 min). Operative mortality was zero, and morbidity was 21.2 % (n = 11), including hemorrhage (n = 3, 5.8 %), biliary fistula (n = 1, 1.9 %), pulmonary infection (n = 1, 1.9 %), delayed gastric emptying (n = 2, 3.8 %), abdominal abscess caused by biliary fistula or PF formation (n = 2, 3.8 %), and POPF (n = 2, 3.8 %). Two patients developed a pancreatic fistula (one type A, one type B) classified according to the International Study Group on Pancreatic Fistula.

Conclusions: The described technique is a simple and safe reconstruction procedure after LPD, especially for patients with nondilated pancreatic duct.

Keywords: Laparoscopic pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative pancreatic fistula.

MeSH terms

  • Abdominal Abscess / epidemiology
  • Adenocarcinoma / surgery*
  • Adult
  • Aged
  • Ampulla of Vater
  • Anastomosis, Surgical / methods
  • Bile Duct Neoplasms / surgery
  • Biliary Fistula / epidemiology*
  • Crohn Disease / surgery
  • Cystadenoma, Mucinous / surgery
  • Duodenal Neoplasms / surgery*
  • Female
  • Gastrointestinal Stromal Tumors / surgery
  • Gastroparesis / epidemiology
  • Humans
  • Laparoscopy / methods
  • Lymphoma / surgery
  • Male
  • Middle Aged
  • Operative Time
  • Pancreas / surgery
  • Pancreatic Ducts / surgery*
  • Pancreatic Fistula / epidemiology*
  • Pancreatic Neoplasms / surgery*
  • Pancreaticoduodenectomy / methods*
  • Pancreaticojejunostomy / methods*
  • Postoperative Complications / epidemiology
  • Postoperative Hemorrhage / epidemiology*
  • Reproducibility of Results
  • Suture Techniques
  • Sutures