End-to-end invaginated pancreaticojejunostomy during minimally invasive pancreatoduodenectomy: technical description and single center experience.
End-to-end pancreaticojejunostomy
Laparoscopic pancreatoduodenectomy
Minimally invasive pancreatic surgery
Postoperative pancreatic fistula
Robotic pancreatoduodenectomy
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
15
03
2023
accepted:
15
07
2023
medline:
31
8
2023
pubmed:
2
8
2023
entrez:
2
8
2023
Statut:
ppublish
Résumé
Remarkable progress has been made in pancreatic surgery over the last decades with the introduction of minimally invasive techniques. Minimally invasive pancreatoduodenectomy (MIPD) remains one of the most challenging operations in abdominal surgery and it is performed in a few centers worldwide. The treatment of the pancreatic stump is a crucial step of this operation; however, the best strategy to perform pancreatic anastomosis is still debated. In this article, we describe the technical details of our original technique of modified minimally invasive end-to-end invaginated pancreaticojejunostomy (EIPJ) using video footage. In the current study, we retrospectively analyzed a pilot series of 67 consecutive cases of minimally invasive (7 robotic/60 fully laparoscopic) MIPD operated on at the General Surgery Department of the Panico Hospital, Tricase (Italy) between March 2017 and October 2022.The reconstruction phase involved an EIPJ, tailored using an intra-ductal anastomotic plastic stent. The aim of this study was to describe the technique and evaluate the short-term outcomes of patients undergoing MIPD with EIPJ. The mean operative time to perform the EIPJ was 21.57 ± 3.32 min. Seven patients (10.5%) developed biochemical leaks and 13 (19.4%) developed clinically relevant pancreatic fistulas (grade B or C according to the definition of the International Study Group on Pancreatic Surgery). The early results confirm that this anastomosis is safe, easy to perform, and effective in the hands of hepatobiliopancreatic (HBP) surgeons with experience in minimally invasive surgery.
Sections du résumé
BACKGROUND
Remarkable progress has been made in pancreatic surgery over the last decades with the introduction of minimally invasive techniques. Minimally invasive pancreatoduodenectomy (MIPD) remains one of the most challenging operations in abdominal surgery and it is performed in a few centers worldwide. The treatment of the pancreatic stump is a crucial step of this operation; however, the best strategy to perform pancreatic anastomosis is still debated. In this article, we describe the technical details of our original technique of modified minimally invasive end-to-end invaginated pancreaticojejunostomy (EIPJ) using video footage.
METHODS
In the current study, we retrospectively analyzed a pilot series of 67 consecutive cases of minimally invasive (7 robotic/60 fully laparoscopic) MIPD operated on at the General Surgery Department of the Panico Hospital, Tricase (Italy) between March 2017 and October 2022.The reconstruction phase involved an EIPJ, tailored using an intra-ductal anastomotic plastic stent. The aim of this study was to describe the technique and evaluate the short-term outcomes of patients undergoing MIPD with EIPJ.
RESULTS
The mean operative time to perform the EIPJ was 21.57 ± 3.32 min. Seven patients (10.5%) developed biochemical leaks and 13 (19.4%) developed clinically relevant pancreatic fistulas (grade B or C according to the definition of the International Study Group on Pancreatic Surgery).
CONCLUSION
The early results confirm that this anastomosis is safe, easy to perform, and effective in the hands of hepatobiliopancreatic (HBP) surgeons with experience in minimally invasive surgery.
Identifiants
pubmed: 37530988
doi: 10.1007/s00464-023-10316-2
pii: 10.1007/s00464-023-10316-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7370-7375Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410
doi: 10.1007/BF00642443
pubmed: 7915434
Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784
doi: 10.1001/archsurg.138.7.777
pubmed: 12860761
Van Hilst J, de Rooij T, Bosscha K, Brinkman DJ, van Dieren S, Dijkgraaf MG, Gerhards MF, de Hingh IH, Karsten TM, Lips DJ (2019) Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol 4:199–207
doi: 10.1016/S2468-1253(19)30004-4
pubmed: 30685489
Croome KP, Farnell MB, Que FG, Reid-Lombardo K, Truty MJ, Nagorney DM, Kendrick ML (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg 260:633–640
doi: 10.1097/SLA.0000000000000937
pubmed: 25203880
Kabir T, Tan HL, Syn NL, Wu EJ, Kam JH, Goh BK (2021) Outcomes of laparoscopic, robotic, and open pancreatoduodenectomy: a network meta-analysis of randomized controlled trials and propensity-score matched studies. Surgery. https://doi.org/10.1016/j.surg.2021.07.020
doi: 10.1016/j.surg.2021.07.020
pubmed: 34454723
Da Dong X, Felsenreich DM, Gogna S, Rojas A, Zhang E, Dong M, Azim A, Gachabayov M (2021) Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis. Sci Rep 11:1–20
Klompmaker S, van Hilst J, Wellner UF, Busch OR, Coratti A, D’Hondt M, Dokmak S, Festen S, Kerem M, Khatkov I (2020) Outcomes after minimally-invasive versus open pancreatoduodenectomy: a pan-European propensity score matched study. Ann Surg 271:356–363
doi: 10.1097/SLA.0000000000002850
pubmed: 29864089
Bassi C, Marchegiani G, Dervenis C, Sarr M, Hilal MA, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591
doi: 10.1016/j.surg.2016.11.014
pubmed: 28040257
Mungroop TH, Klompmaker S, Wellner UF, Steyerberg EW, Coratti A, D’Hondt M, de Pastena M, Dokmak S, Khatov I, Saint-Marc O (2021) Updated alternative fistula risk score (ua-FRS) to include minimally invasive pancreatoduodenectomy: pan-European validation. Ann Surg 273:334–340
doi: 10.1097/SLA.0000000000003234
pubmed: 30829699
Olakowski M, Grudzińska E, Mrowiec S (2020) Pancreaticojejunostomy—a review of modern techniques. Langenbecks Arch Surg 405:13–22
doi: 10.1007/s00423-020-01855-6
pubmed: 31975148
pmcid: 7036071
Ielpo B, Anselmo A, Koh Y, Burdio F, De Blasi V, Sanchez-Velazquez P, Azagra JS, Huscher C, Giuliani A, Pellino G (2023) Minimally invasive pancreatic anastomosis after pancreaticoduodenectomy: multi-institutional step by step video description of the technique. Updates Surg 75(1):255–259. https://doi.org/10.1007/s13304-022-01389-0
doi: 10.1007/s13304-022-01389-0
pubmed: 36371550
Shrikhande SV, Sivasanker M, Vollmer CM, Friess H, Besselink MG, Fingerhut A, Yeo CJ, Fernandez-delCastillo C, Dervenis C, Halloran C (2017) Pancreatic anastomosis after pancreatoduodenectomy: a position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 161:1221–1234
doi: 10.1016/j.surg.2016.11.021
pubmed: 28027816
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768
doi: 10.1016/j.surg.2007.05.005
pubmed: 17981197
Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD, De Santibañes E, Pekolj J, Slankamenac K, Bassi C (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196
doi: 10.1097/SLA.0b013e3181b13ca2
pubmed: 19638912
Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, Talamini G, Pederzoli P (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252:207–214
doi: 10.1097/SLA.0b013e3181e61e88
pubmed: 20622661
Schuh F, Mihaljevic AL, Probst P, Trudeau MT, Müller PC, Marchegiani G, Besselink MG, Uzunoglu F, Izbicki JR, Falconi M et al (2023) A simple classification of pancreatic duct size and texture predicts postoperative pancreatic fistula: a classification of the International Study Group of Pancreatic Surgery (ISGPS). Ann Surg 277(3):e597–e608. https://doi.org/10.1097/SLA.0000000000004855
doi: 10.1097/SLA.0000000000004855
pubmed: 33914473
Andrianello S, Marchegiani G, Malleo G, Masini G, Balduzzi A, Paiella S, Esposito A, Landoni L, Casetti L, Tuveri M, Salvia R, Bassi C (2020) Pancreaticojejunostomy with externalized stent vs Pancreaticogastrostomy with externalized stent for patients with high-risk pancreatic anastomosis: a single-center, phase 3, randomized clinical trial. JAMA Surg 155:313–321
doi: 10.1001/jamasurg.2019.6035
pubmed: 32101272
Peng SY, Mou YP, Liu YB, Su Y, Peng CH, Cai XJ, Wu YL, Zhou LH (2003) Binding pancreaticojejunostomy: 150 consecutive cases without leakage. J Gastrointest Surg 7:898–900
doi: 10.1007/s11605-003-0036-6
pubmed: 14592664
Shrikhande SV, Sivasanker M, Vollmer CM, Friess H, Besselink MG, Fingerhut A, Yeo CJ, Fernandez-delCastillo C, Dervenis C, Halloran C, Gouma DJ, Radenkovic D, Asbun HJ, Neoptolemos JP, Izbicki JR, Lillemoe KD, Conlon KC, Fernandez-Cruz L, Montorsi M, Bockhorn M, Adham M, Charnley R, Carter R, Hackert T, Hartwig W, Miao Y, Sarr M, Bassi C, Büchler MW (2017) Pancreatic anastomosis after pancreatoduodenectomy: a position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 161:1221–1234
doi: 10.1016/j.surg.2016.11.021
pubmed: 28027816
Müssle B, Zühlke L, Wierick A, Sturm D, Grählert X, Distler M, Rahbari NN, Weitz J, Welsch T (2018) Pancreatoduodenectomy with or without prophylactic falciform ligament wrap around the gastroduodenal artery stump for prevention of pancreatectomy hemorrhage. Trials 19:222
doi: 10.1186/s13063-018-2580-0
pubmed: 29650056
pmcid: 5898061
Wiggins T, Majid MS, Markar SR, Loy J, Agrawal S, Koak Y (2020) Benefits of barbed suture utilisation in gastrointestinal anastomosis: a systematic review and meta-analysis. Ann Royal College Surg Engl 102:153–159
doi: 10.1308/rcsann.2019.0106
Velotti N, Manigrasso M, Di Lauro K, Vertaldi S, Anoldo P, Vitiello A, Milone F, Musella M, De Palma GD, Milone M (2021) Barbed suture in gastro-intestinal surgery: a review with a meta-analysis. The Surgeon. https://doi.org/10.1016/j.surge.2021.02.011
doi: 10.1016/j.surge.2021.02.011
pubmed: 33820730
Azagra JS, Makkai-Popa S-T, Pascotto B, Arru L, De Blasi V, Ramia JM, Ibanez-Aguirre FJ, Goergen M (2020) Laparoscopic pancreaticojejunal anastomosis using knotless barbed absorbable sutures are simple, safe and effective: an experience with 34 procedures. Laparosc Surg 4:27
doi: 10.21037/ls.2020.03.07