Reverse Needle Continuous Suture of the Pancreatic Duct to Jejunal Mucosal Pancreaticointestinal Anastomosis in Laparoscopic Pancreaticoduodenectomy

Summary

To circumvent the difficulty in completing the anastomosis of the pancreatic duct and jejunal mucosa under laparoscopy for patients with a small pancreatic duct and soft and fragile pancreatic tissue, we introduce a reverse needle continuous suture technique for laparoscopic pancreaticojejunostomy of the pancreatic duct and jejunal mucosa.

Abstract

Laparoscopic pancreaticoduodenectomy (LPD) is considered the Mount Everest surgery in laparoscopic surgery due to its complex surgical process, high technical requirements, and high incidence of complications. Pancreatic leakage is a common complication of LPD, and severe pancreatic leakage can endanger the patient's life. The occurrence of pancreatic leakage is influenced by multiple factors, and the choice of pancreaticointestinal anastomosis method and the quality of anastomosis are the only controllable factors during surgery. In order to reduce the occurrence of pancreatic leakage, especially severe pancreatic leakage (grade B/C), pancreatic surgeons have continuously improved and innovated the LPD pancreaticointestinal anastomosis method in recent years. Pancreatic duct jejunal mucosal anastomosis is one of the most widely used pancreatic intestinal anastomosis procedures and has been internationally recognized. Due to the unique perspective, operational limitations, and lack of tactile sensation of laparoscopic suturing, it is difficult to complete the anastomosis of the pancreatic duct and jejunal mucosa under laparoscopy for patients with small pancreatic ducts (< 3 mm) and soft and fragile pancreatic tissue. Our team innovatively applied laparoscopic reverse needle continuous suturing of the pancreatic duct to the jejunal mucosa for pancreas-intestine anastomosis. Compared with the traditional laparoscopic pancreatic duct to jejunal mucosa for pancreas intestine anastomosis, it is more in line with the laparoscopic operation perspective, reduces the difficulty of suturing, shortens the anastomosis time, improves the quality of anastomosis, and reduces the occurrence of pancreatic leakage. Moreover, it can reduce the consumption of sutures and minimize the number of knots.

Introduction

Laparoscopic pancreaticoduodenectomy (LPD) is mainly used to treat malignant tumors around the pancreatic head and ampulla. As first described by Gagner and Pomp in 1994, LPD has the advantages of short hospitalization time and low accidental readmission rate. Compared with traditional open pancreaticoduodenectomy, it has outstanding advantages in reducing pain and shortening hospital stay^1,2. Pancreatic leakage is a common complication of LPD, and severe pancreatic leakage can endanger the patient's life. The occurrence of pancreatic fistula is influenced by various factors. Choosing a reasonable method f....

Protocol

This study was approved by the ethics committee of our institution, and all patients provided informed consent before participating in the study. The protocol follows the guidelines of the Ethical Review Measures for Biomedical Research Involving Human Subjects (2016), WMA Helsinki Declaration, and CIOMS International Ethical Guidelines for Human Biomedical Research, and was reviewed by the Ethics Committee of Meizhou People's Hospital. Each patient signed an informed consent form for the surgical plan before the surgery.

1. Preoperative steps

1. Administer CT and MR examinations before surgery and perform diag....

Results

From February 2022 to December 2024, the same medical team innovatively used reverse needle continuous suture of the pancreatic duct for 32 cases of jejunal mucosal pancreaticojejunostomy in LPD. According to the 2016 version of the postoperative pancreatic fistula grading criteria⁷, there were 3 cases of B-grade pancreatic fistula, with an incidence rate of 9.4%. There was no C-grade pancreatic leakage, and good treatment results were achieved. We retrospectively analyzed the main intraoperative .......

Discussion

Blumgart pancreaticointestinal anastomosis is a pancreatic intestinal anastomosis technique pioneered by Professor Blumgart at Memorial Sloan Kettering Cancer Center Hospital in 2002⁸. Since its application, Blumgart's pancreaticointestinal anastomosis has gradually been proven to be a safe and effective surgical method due to its lower incidence of pancreatic fistula⁹. The application of this anastomosis is also controversial: if 4-6 non-absorbable threads are needed, .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
aspirator	Kangji
clips	Kangji
Dissecting forceps	Kangji
Electrocoagulation hook	Kangji
Hemolok	Kangji
High definition laparoscope	STORZ
needle holder	Kangji
Non damaging gripper	Kangji
Polypropylene non absorbable suture	Johnson	HS6855H 0/4
silk thread	Holycon	Number 0
silk thread	Holycon	Number 1
silk thread	Holycon	Number 4
Suction tube	Kangji
Surgical scissors	Kangji
Synthetic absorbable surgical suture	Johnson	Z148H 0/5
ultrasonic knife	Johnson