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Application of a sectional U-shaped reinforcement combined with penetrating pancreaticojejunostomy (U-PPJ) for soft pancreas in laparoscopic pancreatic surgery

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Abstract

Laparoscopic techniques have been widely used in pancreatic surgery, such as laparoscopic pancreaticoduodenectomy (LPD) and laparoscopic central pancreatectomy (LCP). Laparoscopic pancreaticojejunostomy (LPJ) is a common procedure for LPD and LCP, and is also the most critical. The quality of LPJ is associated with the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF). Although LPJ technology has been greatly improved, CR-POPF cannot be completely avoided especially to soft pancreas, which is an important reason for the high risk of laparoscopic pancreatic surgery. To date, there is a lack of standard LPJ approaches. Here, we report a U-shaped suture reinforcement for soft pancreatic section combined with penetrating pancreaticojejunostomy (PPJ) technique, called U-PPJ. Twenty-three patients with soft pancreas who underwent laparoscopic pancreatic surgery adopting U-PPJ method between 2017 and 2022 were enrolled (LPD = 19, LCP = 4). Preoperative, intraoperative and postoperative indexes were collected and analyzed. The results showed that all patients treated with U-PPJ were discharged without drainage tube or a small amount of exudate in the drainage tube does not require clinical treatment, but only needs to be removed after 2 days of observation. The average operation time was 417.35 min. The intraoperative blood loss was 171.74 ml. The pancreatic duct diameter was 3.41 mm. The average postoperative hospitalization days were 11.83 days. The average postoperative drainage tube removal time was 13.26 days. The incidence of postoperative B-grade pancreatic fistula was 4.3%, and no C-grade pancreatic fistula occurred. In our experience, U-PPJ can be completed by a skilled surgeon in less than 20 min. U-PPJ is safe, reliable, convenient and has a low incidence of CR-POPF in soft pancreas, which is worthy of clinical application. It also provides more options for laparoscopic pancreatic surgery. Since this is a retrospective study with a small number of cases, more prospective multicenter studies are needed to further verify its safety and efficacy.

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Acknowledgements

The authors would like to express their gratitude to EditSprings (https://www.editsprings.cn) for the expert linguistic services provided and Hui Wang for offering us a hand-drawn surgical map.

Funding

This study was funded by the Anhui province key research and development project (202004j07020051) and Yijishan Hospital talent introduction and peak plans (YR202122, GF2019T03, GF2019G03).

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  1. Daohai Qian and Bin Liu have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, 240001, Anhui, People’s Republic of China

    Daohai Qian, Bin Liu, Shihang Xi, Xu Wang & Xiaoming Wang

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  1. Daohai Qian
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  2. Bin Liu
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  3. Shihang Xi
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  4. Xu Wang
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  5. Xiaoming Wang
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Contributions

Daohai Qian and Bin Liu designed and conducted this study, analyzed the result and wrote the paper; Shihang Xi and Xu Wang managed the patients and collected clinical data; Xiaoming Wang revised the manuscript for intellectual content. All authors read and approved the final manuscript.

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Correspondence to Daohai Qian.

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DHQ: no conflict; BL: no conflict; SHX: no conflict; XW: no conflict; XMW: no conflict.

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The authors declare that no experiments were performed on humans or animals for this study.

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This retrospective study was approved and the requirement to obtain informed written consent was waived.

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Qian, D., Liu, B., Xi, S. et al. Application of a sectional U-shaped reinforcement combined with penetrating pancreaticojejunostomy (U-PPJ) for soft pancreas in laparoscopic pancreatic surgery. Updates Surg 75, 1117–1122 (2023). https://doi.org/10.1007/s13304-023-01468-w

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