Clinical application of “enfolded pancreatic duct” pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy: analysis of 132 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Xiaobing , HE Yonggang , TANG Yichen ,  LI Jing

Department of Hepatobiliary Surgery, Xinqiao Hospital, Army Medical University, Chongqing 400037, P. R. China;

Corresponding author：

LI Jing, Email: xqyylj@163.com

Keywords：

“enfolded pancreatic duct”pancreaticojejunostomy; laparoscope; pancreaticoduodenectomy; pancreatic leakage

DOI：

10.7507/1007-9424.202205052

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the application value of “enfolded pancreatic duct”pancreaticojejunostomy (PJ) during laparoscopic pancreaticoduodenectomy (LPD). Methods The clinicopathologic data of patients underwent LPD and “enfolded pancreatic duct” PJ from May 2020 to March 2022 were collected retrospectively. The time of PJ was recorded. And the pancreatic leakage, biliary leakage, chyle leakage, bleeding and infection, and death within 30 d after the operation were observed. Results A total of 132 patients were collected, including 60 males and 72 females. The age of patients was (58.6±10.9) years old. There were 38 cases of pancreatic head cancer, 17 cases of duodenum carcinoma, 17 cases of inferior segment cholangiocarcinoma, and 23 cases of duodenal papilla carcinoma, 7 cases of pancreatic neuroendocrine tumor, 11 cases of pancreatic intraductal papilloma, 5 cases of duodenal stromal tumor, 5 cases of duodenal papillary adenoma, 6 cases of pancreatic cyst adenoma, and 3 cases of pancreatic head stone. None of the patients was converted to open surgery. The diameter of pancreatic duct before operation was (3.43±2.11) mm, which were <3 mm in 31 cases. The time of PJ was (20.61±3.16) min. The pancreatic leakage occurred in 17 cases, including 11 cases of grade A leakage, 6 cases of grade B leakage, and none of grade C leakage. There was 1 case of bile leakage, 6 cases of chyle leakage, 5 cases of postoperative bleeding (2 cases of intraabdominal bleeding and 3 cases of gastrointestinal anastomotic bleeding), 3 cases of intraabdominal infection, and no death. None of the patients was readmission due to complications after 90 d of follow-up. Conclusions From summary results of this group of cases, compared with the traditional PJ method, “enfolded pancreatic duct” PJ is less difficult and simpler to operate, which can obviously shorten the PJ time during LPD and reduce the incidence of pancreatic leakage. It is especially suitable for laparoscopic application.

Citation： HUANG Xiaobing, HE Yonggang, TANG Yichen, LI Jing. Clinical application of “enfolded pancreatic duct” pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy: analysis of 132 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(10): 1261-1265. doi: 10.7507/1007-9424.202205052 Copy

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2.	Zhang S, Lan Z, Zhang J, et al. Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis. Oncotarget, 2017, 8(28): 46449-46460.
3.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
4.	Qin R, Kendrick ML, Wolfgang CL, et al. International expert consensus on laparoscopic pancreaticoduodenectomy. Hepatobiliary Surg Nutr, 2020, 9(4): 464-483.
5.	李永彬, 彭兵. 腹腔镜胰十二指肠切除术的现状与思考. 中国普外基础与临床杂志, 2021, 28(9): 1121-1124.
6.	He T, Zhao Y, Chen Q, et al. Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a systematic review and meta-analysis. Dig Surg, 2013, 30(1): 56-69.
7.	Varco RL. A method of implanting the pancreatic duct into the jejunum in the Whipple operation for carcinoma of the pancreas; case report. Surgery, 1945, 18: 569-573.
8.	Shinchi H, Takao S, Maemura K, et al. A new technique for pancreaticogastrostomy for the soft pancreas: the transfixing suture method. J Hepatobiliary Pancreat Surg, 2006, 13(3): 212-217.
9.	Wang XA, Wu XS, Cai Y, et al. Single purse-string duct to mucosa pancreaticogastrostomy: a safe, easy, and useful technique after pancreaticoduodenectomy. J Am Coll Surg, 2015, 220(5): e41-e48. doi: 10.1016/j.jamcollsurg.2014.12.059.
10.	Wang W, Zhang Z, Gu C, et al. The optimal choice for pancreatic anastomosis after pancreaticoduodenectomy: a network meta-analysis of randomized control trials. Int J Surg, 2018, 57: 111-116.
11.	Wang M, Xu S, Zhang H, et al. Imbedding pancreaticojejunostomy used in pure laparoscopic pancreaticoduodenectomy for nondilated pancreatic duct. Surg Endosc, 2017, 31(4): 1986-1992.
12.	Cai Y, Luo H, Li Y, et al. A novel technique of pancreaticojejunostomy for laparoscopic pancreaticoduodenectomy. Surg Endosc, 2019, 33(5): 1572-1577.
13.	彭兵, 王昕, 蔡合. 胰肠吻合技巧及研究进展. 中国普外基础与临床杂志, 2019, 26(4): 395-398.
14.	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. Podda M, Gerardi C, Di Saverio S, et al. Robotic-assisted versus open pancreaticoduodenectomy for patients with benign and malignant periampullary disease: a systematic review and meta-analysis of short-term outcomes. Surg Endosc, 2020, 34(6): 2390-2409.
2. Zhang S, Lan Z, Zhang J, et al. Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis. Oncotarget, 2017, 8(28): 46449-46460.
3. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
4. Qin R, Kendrick ML, Wolfgang CL, et al. International expert consensus on laparoscopic pancreaticoduodenectomy. Hepatobiliary Surg Nutr, 2020, 9(4): 464-483.
5. 李永彬, 彭兵. 腹腔镜胰十二指肠切除术的现状与思考. 中国普外基础与临床杂志, 2021, 28(9): 1121-1124.
6. He T, Zhao Y, Chen Q, et al. Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a systematic review and meta-analysis. Dig Surg, 2013, 30(1): 56-69.
7. Varco RL. A method of implanting the pancreatic duct into the jejunum in the Whipple operation for carcinoma of the pancreas; case report. Surgery, 1945, 18: 569-573.
8. Shinchi H, Takao S, Maemura K, et al. A new technique for pancreaticogastrostomy for the soft pancreas: the transfixing suture method. J Hepatobiliary Pancreat Surg, 2006, 13(3): 212-217.
9. Wang XA, Wu XS, Cai Y, et al. Single purse-string duct to mucosa pancreaticogastrostomy: a safe, easy, and useful technique after pancreaticoduodenectomy. J Am Coll Surg, 2015, 220(5): e41-e48. doi: 10.1016/j.jamcollsurg.2014.12.059.
10. Wang W, Zhang Z, Gu C, et al. The optimal choice for pancreatic anastomosis after pancreaticoduodenectomy: a network meta-analysis of randomized control trials. Int J Surg, 2018, 57: 111-116.
11. Wang M, Xu S, Zhang H, et al. Imbedding pancreaticojejunostomy used in pure laparoscopic pancreaticoduodenectomy for nondilated pancreatic duct. Surg Endosc, 2017, 31(4): 1986-1992.
12. Cai Y, Luo H, Li Y, et al. A novel technique of pancreaticojejunostomy for laparoscopic pancreaticoduodenectomy. Surg Endosc, 2019, 33(5): 1572-1577.
13. 彭兵, 王昕, 蔡合. 胰肠吻合技巧及研究进展. 中国普外基础与临床杂志, 2019, 26(4): 395-398.
14. 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 “enfolded pancreatic duct” pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy: analysis of 132 cases

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