Clinical Feasibility of Duct-To-Mucosa Pancreaticojejunostomy in Laparoscopic Pancreaticoduodenectomy : Comparison with the Same Technique in Open Pancreaticoduodenectomy

Abstract

Introduction: Duct-to-mucosa pancreaticojejunostomy (DM-PJ) is one of the most commonly used technique in pancreaticoduodenectomy (PD). However, DM-PJ can be considered technically a challenge procedure in laparoscopic PD (L-PD), especially in cases with small pancreatic duct. Therefore, we will present the clinical feasibility and technical tips for DM-PJ in L-PD. Methods: Between January 2016 and December 2019, we performed 120 cases of PD. Among them, 60 patients underwent totally L-PD. We retrospectively reviewed the medical records to ascertain the safety and the reproducibility of DM-PJ and compared with open DM-PJs. Results: Significant pancreatic fistula [International Study Group on Pancreatic Fistula (ISGPF) grade B or C] in L-PD was less than 10%, and this complication was even more higher than open DM-PJ group. The postoperative mortality in L-PD was nil and this result was also lower than open DM-PJ. The postoperative complication than Clavien-Dindo classification III was identified in 4 patients in L-PD, but recovered by interventional management. The conversion to open PD was required in one patient with tumor invasion to the superior mesenteric vein, but there was no open conversion because of technical difficulty of DM-PJ. Conclusion: We believe that DM-PJ in L-PD can be the standard method as in open PD, because of the magnification of laparoscope and advancement of laparoscopic techniques. And, further development of laparoscopic instruments is essential.