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Application of single-layer continuous duct-to-mucosa pancreaticojejunostomy with two figure-of-eight sutures in total laparoscopic pancreaticoduodenectomy

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Abstract

Introduction

To investigate the application potential of single-layer continuous duct-to-mucosa pancreaticojejunostomy with two figure-of-eight sutures (“1 + 2” PJ) in total laparoscopic pancreaticoduodenectomy (TLPD). Explore the advantages of “1 + 2” PJ over the traditional double-layer interrupted duct-to-mucosa pancreaticojejunostomy (traditional PJ).

Methods

We retrospectively collected the clinical data of 184 patients who were admitted in our department from Oct 2019 to Oct 2022, including 95 cases who underwent TLPD with “1 + 2” PJ and 89 cases who underwent TLPD with traditional PJ. The pre/intra/postoperation data were analyzed and compared.

Results

The “1 + 2” PJ procedures were successfully performed in all the 95 cases. When compared with the traditional PJ group, there were no statistically significant variations between the pre-operative and pathological data. However, the “1 + 2” PJ group had a shorter operation time (235 (210, 300) minutes vs. 310 (270, 360) minutes in the traditional PJ group, P < 0.001), shorter pancreaticojejunostomy time (15 (10, 20) minutes vs. 50 (45, 55) minutes in the traditional PJ group, P < 0.001), lower pancreatic fistula (both grade B/C) rate (4.21% vs. 12.34% in the traditional group, P = 0.044), and abdominal infection rate (2.11% vs. 8.99% in the traditional group, P = 0.044), as well as reduced hospital stay (11 (9, 15) days vs. 13 (11, 15) days in the traditional PJ group, P = 0.013). In the “1 + 2” PJ group, the median diameter of the pancreatic duct was 3 (3, 4) mm; 82 cases (86.31%) had a normal pancreatic texture, while nine (9.47%) cases had a hard texture, and seven (7.37%) cases had a soft texture; the median intraoperative blood loss was 200 (100, 400) mL and 19 cases (20.00%) needed intraoperative transfusion; eight cases (8.4%) developed postoperative complications, including four cases (4.2%) of pancreatic fistula (including both grade B/C), one case (1.1%) of bile leakage, three cases (3.2%) of delayed gastric emptying, three cases (3.2%) of postoperative hemorrhage, two cases (2.1%) of abdominal infection, and one case (1.1%) of reoperation; the median hospital stay was 13 (8, 17) days; 25 cases were pathologically classified as pancreatic cancer, 35 cases as bile duct cancer, 23 cases as duodenal cancer, and 12 cases as ampullary cancer.

Conclusion

Single-layer continuous duct-to-mucosa pancreaticojejunostomy with two figure-of-eight sutures is a feasible and safe procedure that can be applied in TLPD.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The manuscript has been approved by the Institutional Ethics Committee(s) of the Second Hospital of Hebei Medical University.

Funding

No competing financial interests exist. This work was supported by the Nature Science Foundation of Hebei Province of China under Grant No. H2022206284.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China

    Dongrui Li, Chengxu Du, Weihong Zhao, Siyuan Li, Haitao Lv & Wenbin Wang

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  1. Dongrui Li
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  2. Chengxu Du
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  3. Weihong Zhao
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  4. Siyuan Li
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Contributions

DRL, CXD, WHZ, SYL, HTL, and WWB did the clinical work, collected, and analyzed the preclinical and clinical data. WBW and LDR wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Wenbin Wang.

Ethics declarations

Ethics approval and consent to participate

This study was performed in accordance with the relevant guidelines and regulations and was approved by the Research Ethics Committee of the Second Hospital of Hebei Medical University (No. 2019-R209). Written informed consent was obtained from all the study subjects.

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The written consent to publish the images and clinical details of the participants in this study was obtained from study participants. Proof of consent to publish from study participants can be requested at any time.

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The authors declare no competing interests.

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Li, D., Du, C., Zhao, W. et al. Application of single-layer continuous duct-to-mucosa pancreaticojejunostomy with two figure-of-eight sutures in total laparoscopic pancreaticoduodenectomy. Langenbecks Arch Surg 408, 434 (2023). https://doi.org/10.1007/s00423-023-03155-1

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