A novel technique of pancreaticojejunostomy for laparoscopic pancreaticoduodenectomy.
Laparoscopic
Pancreatic fistula
Pancreaticoduodenectomy
Pancreaticojejunostomy
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
08
05
2018
accepted:
05
09
2018
pubmed:
12
9
2018
medline:
3
4
2020
entrez:
12
9
2018
Statut:
ppublish
Résumé
Pancreaticojejunostomy (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. We 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. Only 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 358 min (220 min to 495 min). The mean duration for PJ was 23 min (19 min to 33 min). The mean estimated blood loss was 112 ml (50 ml to 800 ml). 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%. Bing'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.
Sections du résumé
BACKGROUND
Pancreaticojejunostomy (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.
METHODS
We 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.
RESULTS
Only 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 358 min (220 min to 495 min). The mean duration for PJ was 23 min (19 min to 33 min). The mean estimated blood loss was 112 ml (50 ml to 800 ml). 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%.
CONCLUSIONS
Bing'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.
Identifiants
pubmed: 30203206
doi: 10.1007/s00464-018-6446-z
pii: 10.1007/s00464-018-6446-z
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1572-1577Références
Surgeon. 2014 Aug;12(4):227-34
pubmed: 24525404
Int J Surg. 2015 Jan;13:84-89
pubmed: 25481836
Am J Surg. 2015 Jun;209(6):1074-82
pubmed: 25743406
Surgery. 2017 Mar;161(3):584-591
pubmed: 28040257
Surgery. 2007 Nov;142(5):761-8
pubmed: 17981197
J Hepatobiliary Pancreat Surg. 2006;13(3):185-9
pubmed: 16708292
Surgery. 1998 Jun;123(6):617-21
pubmed: 9626311
Surg Endosc. 1994 May;8(5):408-10
pubmed: 7915434
Ann Surg Oncol. 2008 Jan;15(1):175-85
pubmed: 17909913
Hepatogastroenterology. 2011 Nov-Dec;58(112):2132-9
pubmed: 22024085
Zentralbl Chir. 2001 Jun;126(6):479-81
pubmed: 11446072
Int J Surg. 2016 Dec;36(Pt A):240-247
pubmed: 27826046
Surg Endosc. 2016 Dec;30(12):5173-5184
pubmed: 27005287
Ann Surg. 2015 May;261(5):882-7
pubmed: 24979604
J Gastrointest Surg. 2015 Oct;19(10):1900-9
pubmed: 26264363
JAMA Surg. 2017 Apr 1;152(4):336-342
pubmed: 28030713
J Am Coll Surg. 2009 May;208(5):738-47; discussion 747-9
pubmed: 19476827
J Gastrointestin Liver Dis. 2008 Mar;17(1):43-7
pubmed: 18392243
World J Surg. 2016 May;40(5):1218-25
pubmed: 26830906
Dig Surg. 2004;21(1):54-9
pubmed: 14707394
J Gastrointest Surg. 2014 Sep;18(9):1693-704
pubmed: 24903847
J Am Coll Surg. 2007 Mar;204(3):356-64
pubmed: 17324768