Wrapping pancreaticojejunostomy using the ligamentum teres hepatis during laparoscopic pancreaticoduodenectomy: a propensity score matching analysis.
Laparoscopic pancreaticoduodenectomy
Ligamentum teres hepatis
Pancreaticojejunostomy
Postoperative pancreatic fistula
Propensity score matching analysis
Journal
World journal of surgical oncology
ISSN: 1477-7819
Titre abrégé: World J Surg Oncol
Pays: England
ID NLM: 101170544
Informations de publication
Date de publication:
18 Nov 2023
18 Nov 2023
Historique:
received:
31
08
2023
accepted:
13
11
2023
medline:
20
11
2023
pubmed:
18
11
2023
entrez:
18
11
2023
Statut:
epublish
Résumé
It is controversial whether wrapping around the pancreaticojejunostomy (PJ) could reduce the rate of postoperative pancreatic fistula (POPF), especially in laparoscopic pancreaticoduodenectomy (LPD). This study aims to summarize our single-center initial experience in wrapping around PJ using the ligamentum teres hepatis (LTH) and demonstrate the feasibility and safety of this method. Patients who underwent LPD applying the procedure of wrapping around the PJ were identified. The cohort was compared to the cohort with standard non-wrapping PJ. A 1:1 propensity score matching (PSM) was performed to compare the early postoperative outcomes of the two cohorts. Risk factors for POPF were determined by using univariate and multivariate logistic regression analysis. Overall, 143 patients were analyzed (LPD without wrapping (n = 91) and LPD with wrapping (n = 52)). After 1:1 PSM, 48 patients in each cohort were selected for further analysis. Bile leakage, DGE, intra-abdominal infection, postoperative hospital stays, harvested lymph nodes, and R0 resection were comparable between the two cohorts. However, the wrapping cohort was associated with significantly less POPF B (1 vs 18, P = 0.003), POPF C (0 vs 8, P = 0.043), and Clavien-Dindo classification level III-V (5 vs 26, P = 0.010). No patients died due to the clinically relevant POPF in the two cohorts. No patients who underwent the LTH wrapping procedure developed complications directly related to the wrapping procedure. After PSM, whether wrapping was an independent risk factor for POPF (OR = 0.202; 95%CI:0.080-0.513; P = 0.001). Wrapping the LTH around the PJ technique for LPD was safe, efficient, and reproducible with favorable perioperative outcomes in selected patients. However, further validations using high-quality RCTs are still required to confirm the findings of this study.
Sections du résumé
BACKGROUND AND OBJECTIVE
OBJECTIVE
It is controversial whether wrapping around the pancreaticojejunostomy (PJ) could reduce the rate of postoperative pancreatic fistula (POPF), especially in laparoscopic pancreaticoduodenectomy (LPD). This study aims to summarize our single-center initial experience in wrapping around PJ using the ligamentum teres hepatis (LTH) and demonstrate the feasibility and safety of this method.
METHODS
METHODS
Patients who underwent LPD applying the procedure of wrapping around the PJ were identified. The cohort was compared to the cohort with standard non-wrapping PJ. A 1:1 propensity score matching (PSM) was performed to compare the early postoperative outcomes of the two cohorts. Risk factors for POPF were determined by using univariate and multivariate logistic regression analysis.
RESULTS
RESULTS
Overall, 143 patients were analyzed (LPD without wrapping (n = 91) and LPD with wrapping (n = 52)). After 1:1 PSM, 48 patients in each cohort were selected for further analysis. Bile leakage, DGE, intra-abdominal infection, postoperative hospital stays, harvested lymph nodes, and R0 resection were comparable between the two cohorts. However, the wrapping cohort was associated with significantly less POPF B (1 vs 18, P = 0.003), POPF C (0 vs 8, P = 0.043), and Clavien-Dindo classification level III-V (5 vs 26, P = 0.010). No patients died due to the clinically relevant POPF in the two cohorts. No patients who underwent the LTH wrapping procedure developed complications directly related to the wrapping procedure. After PSM, whether wrapping was an independent risk factor for POPF (OR = 0.202; 95%CI:0.080-0.513; P = 0.001).
CONCLUSIONS
CONCLUSIONS
Wrapping the LTH around the PJ technique for LPD was safe, efficient, and reproducible with favorable perioperative outcomes in selected patients. However, further validations using high-quality RCTs are still required to confirm the findings of this study.
Identifiants
pubmed: 37978553
doi: 10.1186/s12957-023-03255-8
pii: 10.1186/s12957-023-03255-8
pmc: PMC10656888
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
356Subventions
Organisme : the National Natural Science Foundation of China
ID : No. 82070678
Informations de copyright
© 2023. The Author(s).
Références
J Am Coll Surg. 2010 Jan;210(1):54-9
pubmed: 20123332
Surgery. 2017 Mar;161(3):584-591
pubmed: 28040257
J Am Coll Surg. 2013 Oct;217(4):e29-34
pubmed: 24054419
Surgery. 2012 Sep;152(3 Suppl 1):S164-71
pubmed: 22819173
Hepatobiliary Pancreat Dis Int. 2015 Jun;14(3):313-9
pubmed: 26063034
Hepatogastroenterology. 2015 Jan-Feb;62(137):187-9
pubmed: 25911894
Ann Surg Oncol. 2020 Oct;27(11):4562-4573
pubmed: 32382892
Int J Surg. 2023 Sep 6;:
pubmed: 37678279
Surgery. 2012 Feb;151(2):183-91
pubmed: 21982073
Surg Today. 1994;24(10):940-1
pubmed: 7894198
Surgery. 2007 Nov;142(5):761-8
pubmed: 17981197
Ann Surg Oncol. 2023 Nov;30(12):7738-7747
pubmed: 37550449
Arch Surg. 2012 Feb;147(2):145-50
pubmed: 22351908
J Am Coll Surg. 2006 Dec;203(6):857-64
pubmed: 17116554
Lancet Gastroenterol Hepatol. 2021 Jun;6(6):438-447
pubmed: 33915091
World J Gastroenterol. 2019 Jul 28;25(28):3722-3737
pubmed: 31391768
Lancet Gastroenterol Hepatol. 2019 Mar;4(3):199-207
pubmed: 30685489
Surgery. 2007 Jul;142(1):20-5
pubmed: 17629996
World J Surg. 2012 Jul;36(7):1672-8
pubmed: 22411089
Medicine (Baltimore). 2023 May 19;102(20):e33759
pubmed: 37335734
Br J Surg. 2017 Oct;104(11):1443-1450
pubmed: 28895142