Clinical application of “Double R” pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

QIU Jianguo , TANG Wei , LI Ming , SHI Zhengrong , WEI Xufu , XIAO Heng ,  DU Chengyou

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding author：

DU Chengyou, Email: duchengyoucyfyy@163.com

Keywords：

laparoscope; pancreaticojejunostomy; pancreaticoduodenectomy; pancreatic fistula

DOI：

10.7507/1007-9424.202001003

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Objective To investigate the clinical effect of “Double R” pancreatojejunostomy in laparoscopic pancreaticoduodenectomy (LPD).Methods The clinical data of 20 patients underwent “Double R” pancreaticojejunostomy in the LPD from November 2018 to December 2019 in this hospital were collected retrospectively. The duration of pancreaticojejunostomy, incidence of postoperative pancreatic fistula, incidence of other complications, mortality, length of stay, and other clinical outcomes were analyzed.Results There were 5 males and 6 females. The age was (56±10) years old. The body mass index was (22.6±4.4) kg/m². The LPDs were successfully performed in all 20 patients, no patient transferred to the laparotomy, and no patient died within 30 d. There were 6 patients with papillary adenocarcinoma of the duodenum, 5 patients with adenocarcinoma of the lower part of the common bile duct, 2 patients with adenocarcinoma of the pancreatic duct, 3 patients with serous cystadenoma of the pancreatic head, 2 patients with intraductal papillary myxoma of the main pancreatic duct of the pancreatic head, 1 patient with duodenal adenoma with high grade intraepithelial neoplasia, 1 patient with metastatic renal clear cell carcinoma of the pancreatic head, 5 patients with soft pancreas, 12 patients with medium texture, 3 patients with hard texture. The diameter of distal pancreatic duct was (2.1±1.7) mm. The operative time was (380±69) min, the duration of pancreaticojejunostomy was (29±15) min, the intraoperative blood loss was (180±150) mL, the postoperative time of anal exhaust (2.2±0.8) d, postoperative time of fluid intake (3.5±1.1) d, postoperative time of half fluid intake (5.5±0.7) d, postoperative time of hospitalization (14±10) d. There were 3 complications in 2 patients, one of which suffered the pulmonary infection, the other suffered the delayed gastric emptying and gastrointestinal anastomosis bleeding, no bile leakage and abdominal hemorrhage happened. There were 2 cases of pancreatic fistula after the operation, all of them were biochemical pancreatic fistula.Conclusions “Double R” pancreaticojejunostomy method has some advantages of convenient operation, short operation time, and low incidence of pancreatic fistula. However, due to the limited sample size, its safety and feasibility still need to be verified by larger samples and more institutions.

Citation： QIU Jianguo, TANG Wei, LI Ming, SHI Zhengrong, WEI Xufu, XIAO Heng, DU Chengyou. Clinical application of “Double R” pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(10): 1216-1220. doi: 10.7507/1007-9424.202001003 Copy

1.	Bassi C, Dervenis C, Butturini G, <italic>et al</italic>. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
2.	Daskalaki D, Butturini G, Molinari E, <italic>et al</italic>. A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients. Langenbecks Arch Surg, 2011, 396(1): 91-98.
3.	Butturini G, Daskalaki D, Molinari E, <italic>et al</italic>. Pancreatic fistula: definition and current problems. J Hepatobiliary Pancreat Surg, 2008, 15(3): 247-251.
4.	Frymerman AS, Schuld J, Ziehen P, <italic>et al</italic>. Impact of postoperative pancreatic fistula on surgical outcome-the need for a classification-driven risk management. J Gastrointest Surg, 2010, 14(4): 711-718.
5.	Targarona J, Pando E, Garatea R, <italic>et al</italic>. Morbidity and mortality rates in relation to the “surgeon factor” after duodenopancreatectomy. Cir Esp, 2007, 82(4): 219-223.
6.	Akamatsu N, Sugawara Y, Komagome M, <italic>et al</italic>. Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage. J Hepatobiliary Pancreat Sci, 2010, 17(3): 322-328.
7.	Berger AC, Howard TJ, Kennedy EP, <italic>et al</italic>. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg, 2009, 208(5): 738-747.
8.	张光亚, 周景师, 李海民, 等. 胰十二指肠切除术中胰肠吻合方式的选择策略. 中华消化外科杂志, 2013, 12(2): 124-127.
9.	Bassi C, Falconi M, Molinari E, <italic>et al</italic>. Duct-to-mucosa <italic>versus</italic> end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery, 2003, 134(5): 766-771.
10.	Kleespies A, Rentsch M, Seeliger H, <italic>et al</italic>. Blumgart anastomosis for pancreaticojejunostomy minimizes severe complications after pancreatic head resection. Br J Surg, 2009, 96(7): 741-750.
11.	Fujii T, Sugimoto H, Yamada S, <italic>et al</italic>. Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg, 2014, 18(6): 1108-1115.
12.	中华医学会外科学分会胰腺外科学组. 腹腔镜胰十二指肠切除手术专家共识(附: 手术流程与主要步骤). 中华外科杂志, 2017, 55(5): 335-339.
13.	Clavien PA, Barkun J, de Oliveira ML, <italic>et al</italic>. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
14.	van Berge Henegouwen MI, Allema JH, van Gulik TM, <italic>et al</italic>. Delayed massive haemorrhage after pancreatic and biliary surgery. Br J Surg, 1995, 82(11): 1527-1531.
15.	Wente MN, Veit JA, Bassi C, <italic>et al</italic>. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1): 20-25.
16.	Grobmyer SR, Rivadeneira DE, Goodman CA, <italic>et al</italic>. Pancreatic anastomotic failure after pancreaticoduodenectomy. Am J Surg, 2000, 180(2): 117-120.
17.	Wente MN, Bassi C, Dervenis C, <italic>et al</italic>. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
18.	Croome KP, Farnell MB, Que FG, <italic>et al</italic>. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
19.	Zhang H, Wu X, Zhu F, <italic>et al</italic>. Systematic review and meta-analysis of minimally invasive <italic>versus</italic> open approach for pancrea-ticoduodenectomy. Surg Endosc, 2016, 30(12): 5173-5184.
20.	Stauffer JA, Coppola A, Villacreses D, <italic>et al</italic>. Laparoscopic <italic>versus</italic> open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.
21.	Aoki S, Miyata H, Konno H, <italic>et al</italic>. Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17564 patients in Japan. J Hepatobiliary Pancreat Sci, 2017, 24(5): 243-251.
22.	Gao F, Li J, Quan S, <italic>et al</italic>. Risk factors and treatment for hemorrhage after pancreaticoduodenectomy: a case series of 423 patients. Biomed Res Int, 2016, 2016: 2815693.
23.	Shrikhande, S V., Qureshi, S S., Rajneesh, N, <italic>et al</italic> Pancreatic anastomoses after pancreaticoduodenectomy: do we need further studies? World journal of surgery, 2005, 29(12): 1642-1649.
24.	Sato N, Yamaguchi K, Chijiiwa K, <italic>et al</italic>. Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg, 1998, 133(10): 1094-1098.
25.	Hong TH, Youn YC, You YK, <italic>et al</italic>. An easy and secure pancreaticogastrostomy after pancreaticoduodenectomy: transpancreatic suture with a buttress method through an anterior gastrotomy. J Korean Surg Soc, 2011, 81(5): 332-338.
26.	Bartoli FG, Arnone GB, Ravera G, <italic>et al</italic>. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Review and statistical meta-analysis regarding 15 years of literature. Anticancer Res, 1991, 11(5): 1831-1848.
27.	王建伟, 许斌, 蔡秀军, 等. 胰十二指肠切除术后胰漏的发生机制. 世界华人消化杂志, 2003, 11(5): 589-590.
28.	苗毅, 卫积书. 从机械连接到生物愈合: 对胰肠吻合新理解. 中国实用外科杂志, 2015, 35(8): 812-814.

1. Bassi C, Dervenis C, Butturini G, <italic>et al</italic>. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
2. Daskalaki D, Butturini G, Molinari E, <italic>et al</italic>. A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients. Langenbecks Arch Surg, 2011, 396(1): 91-98.
3. Butturini G, Daskalaki D, Molinari E, <italic>et al</italic>. Pancreatic fistula: definition and current problems. J Hepatobiliary Pancreat Surg, 2008, 15(3): 247-251.
4. Frymerman AS, Schuld J, Ziehen P, <italic>et al</italic>. Impact of postoperative pancreatic fistula on surgical outcome-the need for a classification-driven risk management. J Gastrointest Surg, 2010, 14(4): 711-718.
5. Targarona J, Pando E, Garatea R, <italic>et al</italic>. Morbidity and mortality rates in relation to the “surgeon factor” after duodenopancreatectomy. Cir Esp, 2007, 82(4): 219-223.
6. Akamatsu N, Sugawara Y, Komagome M, <italic>et al</italic>. Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage. J Hepatobiliary Pancreat Sci, 2010, 17(3): 322-328.
7. Berger AC, Howard TJ, Kennedy EP, <italic>et al</italic>. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg, 2009, 208(5): 738-747.
8. 张光亚, 周景师, 李海民, 等. 胰十二指肠切除术中胰肠吻合方式的选择策略. 中华消化外科杂志, 2013, 12(2): 124-127.
9. Bassi C, Falconi M, Molinari E, <italic>et al</italic>. Duct-to-mucosa <italic>versus</italic> end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery, 2003, 134(5): 766-771.
10. Kleespies A, Rentsch M, Seeliger H, <italic>et al</italic>. Blumgart anastomosis for pancreaticojejunostomy minimizes severe complications after pancreatic head resection. Br J Surg, 2009, 96(7): 741-750.
11. Fujii T, Sugimoto H, Yamada S, <italic>et al</italic>. Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg, 2014, 18(6): 1108-1115.
12. 中华医学会外科学分会胰腺外科学组. 腹腔镜胰十二指肠切除手术专家共识(附: 手术流程与主要步骤). 中华外科杂志, 2017, 55(5): 335-339.
13. Clavien PA, Barkun J, de Oliveira ML, <italic>et al</italic>. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
14. van Berge Henegouwen MI, Allema JH, van Gulik TM, <italic>et al</italic>. Delayed massive haemorrhage after pancreatic and biliary surgery. Br J Surg, 1995, 82(11): 1527-1531.
15. Wente MN, Veit JA, Bassi C, <italic>et al</italic>. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1): 20-25.
16. Grobmyer SR, Rivadeneira DE, Goodman CA, <italic>et al</italic>. Pancreatic anastomotic failure after pancreaticoduodenectomy. Am J Surg, 2000, 180(2): 117-120.
17. Wente MN, Bassi C, Dervenis C, <italic>et al</italic>. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
18. Croome KP, Farnell MB, Que FG, <italic>et al</italic>. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
19. Zhang H, Wu X, Zhu F, <italic>et al</italic>. Systematic review and meta-analysis of minimally invasive <italic>versus</italic> open approach for pancrea-ticoduodenectomy. Surg Endosc, 2016, 30(12): 5173-5184.
20. Stauffer JA, Coppola A, Villacreses D, <italic>et al</italic>. Laparoscopic <italic>versus</italic> open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.
21. Aoki S, Miyata H, Konno H, <italic>et al</italic>. Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17564 patients in Japan. J Hepatobiliary Pancreat Sci, 2017, 24(5): 243-251.
22. Gao F, Li J, Quan S, <italic>et al</italic>. Risk factors and treatment for hemorrhage after pancreaticoduodenectomy: a case series of 423 patients. Biomed Res Int, 2016, 2016: 2815693.
23. Shrikhande, S V., Qureshi, S S., Rajneesh, N, <italic>et al</italic> Pancreatic anastomoses after pancreaticoduodenectomy: do we need further studies? World journal of surgery, 2005, 29(12): 1642-1649.
24. Sato N, Yamaguchi K, Chijiiwa K, <italic>et al</italic>. Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg, 1998, 133(10): 1094-1098.
25. Hong TH, Youn YC, You YK, <italic>et al</italic>. An easy and secure pancreaticogastrostomy after pancreaticoduodenectomy: transpancreatic suture with a buttress method through an anterior gastrotomy. J Korean Surg Soc, 2011, 81(5): 332-338.
26. Bartoli FG, Arnone GB, Ravera G, <italic>et al</italic>. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Review and statistical meta-analysis regarding 15 years of literature. Anticancer Res, 1991, 11(5): 1831-1848.
27. 王建伟, 许斌, 蔡秀军, 等. 胰十二指肠切除术后胰漏的发生机制. 世界华人消化杂志, 2003, 11(5): 589-590.
28. 苗毅, 卫积书. 从机械连接到生物愈合: 对胰肠吻合新理解. 中国实用外科杂志, 2015, 35(8): 812-814.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical application of “Double R” pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy

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