A novel technique of pancreaticojejunostomy for laparoscopic pancreaticoduodenectomy

被引:75
|
作者
Cai, Yunqiang [1 ,2 ]
Luo, Hua [3 ]
Li, Yongbin [2 ]
Gao, Pan [2 ]
Peng, Bing [1 ]
机构
[1] Sichuan Univ, West China Hosp, Dept Pancreat Surg, 37 Guo Xue Alley, Chengdu 610041, Sichuan, Peoples R China
[2] Shangjin Nanfu Hosp, Dept Minimal Invas Surg, Chengdu 610037, Sichuan, Peoples R China
[3] Mianyang Cent Hosp, Dept Hepatobiliary Surg, Mianyang 621000, Peoples R China
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2019年 / 33卷 / 05期
基金
美国国家卫生研究院;
关键词
Laparoscopic; Pancreaticoduodenectomy; Pancreaticojejunostomy; Pancreatic fistula; INTERNATIONAL STUDY-GROUP; PANCREATIC FISTULA; METAANALYSIS; PANCREATICOGASTROSTOMY; DEFINITION; SURGERY; MUCOSA; DUCT;
D O I
10.1007/s00464-018-6446-z
中图分类号
R61 [外科手术学];
学科分类号
摘要
BackgroundPancreaticojejunostomy (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.MethodsWe 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.ResultsOnly 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 358min (220min to 495min). The mean duration for PJ was 23min (19min to 33min). The mean estimated blood loss was 112ml (50ml to 800ml). 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%.ConclusionsBing'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.
引用
收藏
页码:1572 / 1577
页数:6
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