A propensity score-matched analysis of continuous vs interrupted duct-to-mucosa pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy

Abstract

Introduction: Despite marked improvements in postoperative care and widespread adoption of minimally invasive procedures, postoperative pancreatic fistula (POPF) continues to be a major cause of morbidity. While no single technique of PJ has been proven to be superior, a few reports have indicated that continuous duct-to-mucosa anastomosis can reduce operative time and rates of POPF. But, there is limited data on the feasibility and outcomes of this technique in laparoscopic PD. Methods: Prospectively collected data of laparoscopic PD and their recorded operative videos over the past 5 years were collected. After propensity score matching, 30 cases of patients were chosen in Continuous duct-to-mucosa PJ (C-PJ) group and 30 cases in Interrupted Duct-to-mucosa PJ (I-PJ) group and the data was analysed for PJ anastomosis time, total operative time and POPF rates as primary outcomes and hospital stay as secondary outcome. Results: The analysis revealed a significantly shorter time for PJ anastomosis in the C-PJ group. However, the overall operative time did not reach statistical significance. There was no difference in the rates of CR-POPF and hospital stay between the two groups. Conclusion: Continuous suturing for duct-to-mucosa PJ in Laparoscopic PD is feasible even in undilated ducts. Propensity score matched analysis revealed that C-PJ reduces the time for PJ anastomosis while causing no difference in clinically relevant POPF.