Use of primary continuous single-layer pancreaticojejunostomy after linear stapler closure of pancreatic remnants in pancreaticoduodenectomy
10.3760/cma.j.cn113884-20220701-00264
- VernacularTitle:胰颈直线切割闭合加连续单层胰肠吻合在胰十二指肠切除术中的应用研究
- Author:
Wenbing SUN
1
;
Jun GAO
;
Shan KE
;
Shaohong WANG
;
Xinliang KONG
;
Xiangtao WANG
;
Shigang GUO
;
Chunmin NING
;
Jian KONG
;
Shangsheng LI
;
Yanjie XU
;
Li XU
;
Qiang WANG
Author Information
1. 首都医科大学附属北京朝阳医院西院肝胆胰脾外科，北京 100043
- Keywords:
Pancreaticoduodenectomy;
Pancreaticojejunostomy;
Pancreatic fistula;
Pancreatic stapler closure;
Acute pancreatitis
- From:
Chinese Journal of Hepatobiliary Surgery
2022;28(9):678-682
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the use of primary continuous single-layer pancreaticojejunostomy after linear stapler closure of pancreatic neck in pancreaticoduodenectomy (PD).Methods:The clinical data of 21 patients who were treated with primary continuous single-layer pancreaticojejunostomy after linear stapler closure of pancreatic neck in PD at Beijing Chaoyang Hospital Affiliated, West Campus, Capital Medical University, Rizhao Hepatobiliary-pancreatic-splenic Surgery Research Institute, Binzhou Second People’s Hospital, Chaoyang Central Hospital from February 2022 to May 2022 were retrospectively analyzed. There were 12 males and 9 females, with ages ranging from 31.0 to 82.0 years (median age 63.0 years). The success rates of linear stapling at pancreatic neck, time of pancreaticojejunostomy, postoperative complications, pancreatic fistula risk score, and length of hospital stay were studied.Results:Among the 21 patients, there were 3 patients who underwent open PD and 18 patients who underwent laparoscopic PD. Primary continuous single-layer pancreaticojejunostomy after linear stapler closure of pancreatic neck was successfully carried out in all these patients. The success rate was 100.0%. The success rate of finding pancreatic ducts at the pancreatic stumps and inserting an drainage tube was 100.0%(21/21). In the 3 patients who underwent open PD, the operation time were 230.0, 245.0 and 250.0 minutes respectively. The time for completing pancreaticojejunostomy were 12.0, 13.0 and 12.0 minutes respectively. The estimated blood loss were 300.0, 450.0 and 600.0 ml respectively. The length of hospital stay were 14.0, 15.0 and 21.0 days. In the 18 patients who underwent laparoscopic PD, the operation time was (295.9±14.5) min, the time for constructing pancreaticojejunostomy was (22.3±1.5) min, the blood loss was (180.0±40.0) ml, the length of hospital stay ranging from 8.0 to 16.0 days (median 10.5 days). Among all the 21 patients, the pancreatic fistula risk score was (4.7±1.5). Postoperative acute pancreatitis occurred in 3 patients (14.3%), delayed gastric emptying occurred in 4 patients (19.0%), and all of them recovered after conservative treatment. There was no postoperative bleeding, nosocomial infection, grade B and C postoperative pancreatic fistula or perioperative death.Conclusion:The continuous single-layer pancreaticojejunostomy after linear stapler closure of the pancreatic neck was safe, reliable, simple and technically easy. It has the potential to prevent clinical postoperative pancreatic fistula and pancreaticojejunostomy bleeding. It is worth to popularize this surgical procedure.
