A duct-to-mucosa pancreaticojejunostomy for small main pancreatic duct and soft pancreas in minimally invasive pancreaticoduodenectomy

Surgical Endoscopy · 13 authors, 3 centres

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The technique resulted in a clinically relevant postoperative pancreatic fistula rate of 4.1% and was feasible for high-risk features like small pancreatic ducts and soft pancreatic texture.

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The primary aim was to assess the technique's effectiveness in preventing postoperative pancreatic fistula (POPF), especially in high-risk cases with a small main pancreatic duct (MPD) ≤3 mm or soft pancreatic texture. Notably, for patients with a small MPD or soft pancreas, the CR-POPF rate was 4% and 4.5%, respectively. The findings suggest the simplified technique is safe and efficient, with potential utility in low-volume centers.

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surgery

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ORIGINAL PAPER

PMC10156865

A duct-to-mucosa pancreaticojejunostomy for small main pancreatic duct and soft pancreas in minimally invasive pancreaticoduodenectomy

Surgical Endoscopy

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ABSTRACT

Abstract Background Postoperative pancreatic fistula (POPF) is often associated with significant morbidity and mortality after the Whipple operation. Patient-related factors associated with POPF include soft pancreatic texture and a small main pancreatic duct (MPD). The traditional duct-to-mucosa anastomosis was modified to be easily performed. The aim of the study was to evaluate the simplified pancreaticojejunostomy (PJ) method in the prevention of POPF after minimally invasive pancreaticoduodenectomy (PD). Methods Ninety-eight patients who underwent laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD) with a simplified PJ procedure containing only two duct-to-mucosa sutures and four penetrating-sutures to anastomose the pancreatic parenchyma and jejunal seromuscular layer in our center were retrospectively studied. Demographics and clinical short-term safety were assessed. Results All LPD and RPD procedures were successfully performed. The median time of PJ was 17 min, and the median blood loss was 60 mL, with only one patient requiring transfusion. Four patients (4.1%) suffered from clinically relevant POPF (CR-POPF), including four grade B cases and no grade C cases. For patients with an MPD diameter of 3 mm or less, POPF was noted in two (4%) of the fifty patients, with all cases being grade B. Of the patients with a soft pancreas, only two (4.5%) patients suffered from grade B POPF. One patient (1.0%) experienced a 90-day mortality. Neither the main pancreatic diameter nor pancreatic texture had an impact on postoperative outcomes. Conclusions Our technique is a simple, safe and efficient alternative to prevent POPF after LPD and RPD. This method is suitable for almost all pancreatic conditions, including cases with a small main pancreatic duct and soft pancreas, and has the potential to become the preferred procedure in low-volume pancreatic surgery centers. Graphical abstract Our modified duct-to-mucosa PJ, which contains only two duct-to-mucosa sutures and four penetrating-sutures to anastomose the pancreatic parenchyma and jejunal seromuscular layer, is ideal for small MPD and soft pancreas when performing minimally invasive PD and has a low rate of POPF. PJ pancreaticojejunostomy, MPD main pancreatic diameter, PD pancreaticoduodenectomy, POPF postoperative pancreatic fistula Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09830-6. Keywords: Minimally invasive pancreaticoduodenectomy, Pancreaticojejunostomy, Pancreatic fistula

CITATION EXPORT

Anbang Zhao, Qian Zhu, Xian Qin et al.. A duct-to-mucosa pancreaticojejunostomy for small main pancreatic duct and soft pancreas in minimally invasive pancreaticoduodenectomy. Surgical Endoscopy. (2023). https://doi.org/10.1007/s00464-022-09830-6

AUTHORS

13 · 3 CENTRES

Anbang Zhao, Qian Zhu, Xian Qin, Kunlei Wang, Kai Tan, Zhicheng Liu, Wenjing Song, Qian Cheng, Xinyin Li, Zhinan Chen, Zhisu Liu, Yufeng Yuan, Zhiyong Yang

1Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
2Pancreatic Surgery Center, Zhongnan Hospital of Wuhan University, Wuhan, China
3Clinical Medicine Research Center for Minimally Invasive Procedure of Hepatobiliary & Pancreatic Diseases of Hubei Province, Hubei, China