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A novel anastomosis technique facilitates pancreaticojejunostomy in total laparoscopic pancreaticoduodenectomy (with video)

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Abstract

Background

While the best technique for pancreatic anastomosis during Whipple’s procedure remains controversial, laparoscopic pancreaticoduodenectomy (LPD) has been rapidly increasing in popularity. Because of their feasibility and reliability, new pancreatic anastomosis techniques may have vital roles when adapted for LPD. Here, we describe a new pancreaticojejunostomy (PJ) technique using three sutures (termed the “three sutures” PJ technique), which facilitates pancreatic anastomosis during total LPD.

Methods

A total of 149 patients who underwent LPD using the “three sutures” PJ technique at three hospitals were included in this study (81 patients at Guangdong Provincial People’s Hospital [GDPH], 60 patients at Sun Yat-Sen Memorial Hospital [SMH], and 8 patients at Affiliated Hospital of Guangdong Medical University [AHGMU]). Data on the demographic characteristics, operative outcomes, and postoperative results (pancreatic fistula rate, mortality rate, and length of hospital stay) of these patients were collected and analyzed.

Results

A surgical video showing the details of the “three sutures” PJ method was included. The mean operation times at GDPH, SMH, and AHGMU were 4.08 ± 0.99 h, 4.65 ± 1.53 h, and 4.67 ± 0.64 h, respectively, and the average PJ times were 17.96 ± 3.49 min, 18.19 ± 2.63 min, and 22.5 ± 3.96 min, respectively. The numbers of grade B pancreatic fistulas were 9 (11.11%), 2 (3.33%), and 1 (12.50%), respectively, and two patients had grade C fistulas, one each at GDPH and SMH. The numbers of clinically relevant postoperative pancreatic fistula (CR-POPF) were 10 (12.35%), 3 (5.00%), and 1 (12.50%) in each center, respectively. The overall rate of CR-POPF was 9.40% (14/149) among patients of all three centers. The perioperative mortality rate was 0%.

Conclusions

The “three sutures” PJ technique for total LPD is a safe and reliable method, with a low risk of pancreatic fistula, short anastomosis time, and steep learning curve.

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Funding

This study was funded by grants from the National Natural Science Foundation of China (grant number: 82072639).

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Author notes

  1. Yu Zhou, Jiabin Yang, and Lusheng Wei contributed equally to this study.

Authors and Affiliations

  1. Department of Pancreatic Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, 510120, China

    Yu Zhou, Jiabin Yang, Qing Lin, Shangyou Zheng & Rufu Chen

  2. School of Medicine, South China University of Technology, Guangzhou, Guangdong Province, China

    Jiabin Yang

  3. Department of Pancreatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China

    Lusheng Wei & Quanbo Zhou

  4. Department of Hepatobiliary Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China

    Guohua Liu & Xiaoyu Tan

Authors
  1. Yu Zhou
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  2. Jiabin Yang
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  4. Qing Lin
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  7. Quanbo Zhou
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  8. Xiaoyu Tan
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Corresponding authors

Correspondence to Quanbo Zhou, Xiaoyu Tan or Rufu Chen.

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Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare no competing interests.

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Supplementary Information

ESM 1

A. Illustration showing the operation theatre set-up and patient positions during laparoscopic pancreaticoduodenectomy. B. Image of trocar setting for aparoscopic pancreaticoduodenectomy. (PNG 2269 kb)

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Zhou, Y., Yang, J., Wei, L. et al. A novel anastomosis technique facilitates pancreaticojejunostomy in total laparoscopic pancreaticoduodenectomy (with video). Langenbecks Arch Surg 406, 2891–2897 (2021). https://doi.org/10.1007/s00423-021-02347-x

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  • DOI: https://doi.org/10.1007/s00423-021-02347-x

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