Comparison with two pancreatojejunostomy methods in laparoscopic pancreatocduodenectomy

Abstract

Introduction: Despite current advances in surgical technique, laparoscopic pancreatoduodenectomy is a very difficult procedure. A pancreatojejunostomy is a most important part of this surgery. Because a postoperative pancreatic fistula (POPF) sometimes lead to severe complications. The aim of this study is to determine postoperative outcomes following two pancreatojejunostomy methods. And we will present the actual surgery videos of two types of the pancreatojejunostomy with laparoscopic pancreatoduodenectomy. Methods: 25 cases of laparoscopic pancreatoduodenectomy were reviewed as a single institution between May 2011 and July 2014. Pancreatojejunostomy method was performed by two procedure (complete laparoscopically or mini-laparotomy). Results: Most common diseases included NET, papilla of Vater carcinoma (T1 or T2) and IPMN. The laparoscopic group (LG) was 18 patients. The mini-laparotomy group (MG) was 7 patients. The patient's back ground of two groups were similar (age, BMI and diameter of the pancreatic duct). The median procedure time of LG (76 min) was significantly longer than that of MG (46 min). Complication rates and POPF rates were similar with each groups. The median hospital stay of LG (13 days) was shorter than that of MG (32), but not significantly. Conclusions: Postoperative outcomes after laparoscopic pancreatoduodenectomy are unaffected by two different pancreatojejunostomy methods. The degree of difficulty of pancreatojejunostomy with mini-laparotomy depends on the shape of the body. The accumulation of further similar studies will be needed.