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A novel technique of pancreaticojejunostomy for laparoscopic pancreaticoduodenectomy

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Abstract

Background

Pancreaticojejunostomy (PJ) reconstruction is the Achilles’ heel of laparoscopic pancreaticoduodenectomy (LPD). However, only a few studies have focused on the performance of this difficult procedure laparoscopically.

Methods

We present a safe and feasible technique of duct-to-mucosa pancreaticojejunostomy for LPD, named Bing’s anastomosis. Our study included 238 cases of LPDs that underwent Bing’s anastomosis. Data on the demographic characteristics, operative outcomes (total operative time, PJ duration, and estimated blood loss), and postoperative results (length of hospital stay, recovery of bowel function, and rates of postoperative morbidity and mortality) of the cases were prospectively collected and retrospectively analyzed.

Results

Only one patient (0.4%) in our series required conversion to open surgery as a result of uncontrolled bleeding from the superior mesenteric artery. The average operative time was 358 min (220 min to 495 min). The mean duration for PJ was 23 min (19 min to 33 min). The mean estimated blood loss was 112 ml (50 ml to 800 ml). The overall incidence of pancreatic fistula was 21.4% and included 42 cases (17.6%) of biochemical leak, eight cases (3.4%) of Grade B, and one case (0.4%) of Grade C pancreatic fistulas. The 90-day mortality was 0.4%.

Conclusions

Bing’s anastomosis is a safe, reliable, and rapid PJ technique for LPD that is associated with favorable outcomes and a low risk of pancreatic fistula. However, its safety and feasibility should be verified by performing prospective randomized controlled trials at different institutions.

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Funding

This study was funding by National Institutes of Health of China (W2017ZWS07).

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Author notes

  1. Yunqiang Cai and Hua Luo have contributed equally to this study.

Authors and Affiliations

  1. Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China

    Yunqiang Cai & Bing Peng

  2. Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, 610037, China

    Yunqiang Cai, Yongbin Li & Pan Gao

  3. Department of Hepatobiliary Surgery, Mianyang Central Hospital, Mianyang, 621000, China

    Hua Luo

Authors
  1. Yunqiang Cai
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  2. Hua Luo
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  3. Yongbin Li
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  4. Pan Gao
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  5. Bing Peng
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Corresponding author

Correspondence to Bing Peng.

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Disclosures

Dr. Yunqiang Cai, Hua Luo, Yongbin Li, Pan Gao, and Bing Peng have no conflicts of interest or financial ties to disclose.

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Cai, Y., Luo, H., Li, Y. et al. A novel technique of pancreaticojejunostomy for laparoscopic pancreaticoduodenectomy. Surg Endosc 33, 1572–1577 (2019). https://doi.org/10.1007/s00464-018-6446-z

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  • DOI: https://doi.org/10.1007/s00464-018-6446-z

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