External versus internal pancreatic duct drainage for early efficacy after laparoscopic pancreaticoduodenectomy in the early stages of the low-flow center learning curve: a retrospective comparative study

Background: There is no uniform conclusion as to whether internal or external drainage of the supporting duct is more clinically effective, especially in laparoscopic pancreaticoduodenectomy (LPD) which has not yet been reported in clinical studies. This study aimed to investigate the efficacy of external versus internal pancreatic duct drainage during LPD performed in a low-flow center at the beginning of the learning curve. Methods: The clinical data of a total of 73 cases of patients who underwent LPD between January 2022 and June 2024 were retrospectively analyzed. Forty-eight cases performed by doctors from Jingzhou Hospital Affiliated to Yangtze University were considered as not having passed the early stages of the learning curve, and 25 cases performed by the invited team with rich LPD experience were considered as having passed the early stages of the learning curve. According to whether they had passed the early stages of the learning curve or not and the method of pancreatic duct drainage used, 73 patients were divided into the external drainage group (EDG) that did not pass the early stages of the learning curve (n=24), the internal drainage group (IDG) that did not pass the early stages of the learning curve (n=24), and the IDG that passed the early stages of the learning curve (n=25). The EDG was compared with the two IDGs in terms of complication rates and other procedure-related indicators. Results: The total pancreatic fistulae incidence rate of the whole group was 16.4% (12/73), and the incidence of pancreatic fistulae was significantly lower in the EDG that did not pass the early stages of the learning curve (8.3%) than in the IDG that did not pass the early stages of the learning curve (33.3%), with statistically significant difference (P=0.03); the incidence of pancreatic fistulae was slightly higher in the EDG that did not pass the early stages of the learning curve (8.3%) than in the IDG that passed the early stages of the learning curve (8.0%), with statistically not significant difference (P>0.99). The incidence of biliary fistulae in the EDG that did not pass the early stages of the learning curve (0.0%) was lower than that in the IDG that did not pass the early stages of the learning curve (25.0%), and the difference was statistically significant (P=0.02). The differences in other complications between the EDG and the two IDGs were not statistically significant. Conclusions: External pancreatic duct drainage is more helpful in reducing the incidence of postoperative pancreatic fistulae, more conducive to the safe passage of the operator through the initial stages of the LPD learning curve, more suitable for use in the development of LPD in low-volume centers.