A comparison of pancreatojejunostomy using the modified Blumgart anastomosis with or without a four-needle three-loop suture device and continuous sutures for duct-to-mucosa anastomosis in robotic pancreaticoduodenectomy.
Continuous suture
Duct-to-mucosa anastomosis
Modified Blumgart anastomosis
Robotic pancreatoduodenectomy
Robotic pancreatojejunostomy
Journal
Surgery today
ISSN: 1436-2813
Titre abrégé: Surg Today
Pays: Japan
ID NLM: 9204360
Informations de publication
Date de publication:
30 Jul 2024
30 Jul 2024
Historique:
received:
14
02
2024
accepted:
02
07
2024
medline:
31
7
2024
pubmed:
31
7
2024
entrez:
30
7
2024
Statut:
aheadofprint
Résumé
Despite descriptions of different pancreatojejunostomy procedures using robotic pancreaticoduodenectomy (RPD), a standardized procedure has not yet been established. No prior report has described pancreatojejunostomy by RPD combined with modified Blumgart anastomosis with continuous suturing for duct-to-mucosa anastomosis. This study investigated this surgical technique and evaluated the short-term outcomes of the simplified pancreatojejunostomy procedure. Between December 2021 and March 2024, 36 patients underwent pancreatojejunostomy using modified Blumgart anastomosis with continuous suturing for duct-to-mucosa anastomosis using RPD. Patients were divided into an early group (n = 15), without the use of the new four-needle three-loop suture device during the modified Blumgart anastomosis and a late group (n = 21) that did use this device. The late group had a significantly shorter pancreatojejunostomy duration (60 min vs. 49 min, p = 0.004) than the early group. Both groups showed equivalent postoperative outcomes; however, the late group exhibited a trend toward a lower rate of postoperative pancreatic fistula grade ≥ B (26.7% vs. 4.8%, p = 0.138). Pancreatojejunostomy using modified Blumgart anastomosis with a four-needle three-loop suture device and continuous suture for duct-to-mucosa anastomosis in patients undergoing RPD is simple and effective. This new suturing device may further reduce the incidence of postoperative pancreatic fistulas.
Identifiants
pubmed: 39080038
doi: 10.1007/s00595-024-02904-z
pii: 10.1007/s00595-024-02904-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.
Références
Whipple AO. Pancreaticoduodenectomy for islet carcinoma: a five-year follow-up. Ann Surg. 1945;121:847–52.
doi: 10.1097/00000658-194506000-00008
pubmed: 17858621
pmcid: 1618156
Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408–10.
doi: 10.1007/BF00642443
pubmed: 7915434
Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003;138:777–84.
doi: 10.1001/archsurg.138.7.777
pubmed: 12860761
McMillan MT, Soi S, Asbun HJ, Ball CG, Bassi C, Beane JD, et al. Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy: a model for performance evaluation. Ann Surg. 2016;264:344–52.
doi: 10.1097/SLA.0000000000001537
pubmed: 26727086
Waugh JM, Clagett OT. Resection of the duodenum and head of the pancreas for carcinoma; an analysis of thirty cases. Surgery. 1946;20:224–32.
pubmed: 20994806
Kakita A, Takahashi T, Yoshida M, Furuta K. A simpler and more reliable technique of pancreatojejunal anastomosis. Surg Today. 1996;26:532–5.
doi: 10.1007/BF00311562
pubmed: 8840437
Warren KW, Cattell RB. Basic techniques in pancreatic surgery. Surg Clin North Am. 1956;36:707–24.
doi: 10.1016/S0039-6109(16)34896-4
pubmed: 13324659
Hines OJ, Reber HA. Technique of pancreaticojejunostomy reconstruction after pancreaticoduodenectomy. J Hepatobil Pancreat Surg. 2006;13:185–9.
doi: 10.1007/s00534-005-1032-x
Li Z, Wei A, Xia N, Zheng L, Yang D, Ye J, et al. Blumgart anastomosis reduces the incidence of pancreatic fistula after pancreaticoduodenectomy: a systematic review and meta-analysis. Sci Rep. 2020;10:17896.
doi: 10.1038/s41598-020-74812-4
pubmed: 33087777
pmcid: 7578105
Napoli N, Kauffmann EF, Vistoli F, Amorese G, Boggi U. State of the art of robotic pancreatoduodenectomy. Update Surg. 2021;73:873–80.
doi: 10.1007/s13304-021-01058-8
Gai YW, Wang HT, Tan XD. Pancreaticojejunostomy conducive to biological healing in minimally invasive pancreaticoduodenectomy. J Gastrointest Surg. 2022;26:1967–81.
doi: 10.1007/s11605-022-05339-4
pubmed: 35546220
pmcid: 9489565
Ishizawa T, Akamatsu N, Kaneko J, Arita J, Hasegawa K. Closure and anastomosis of the pancreas using a four-needle three-loop suture device. Glob Health Med. 2022;4:225–9.
doi: 10.35772/ghm.2022.01044
pubmed: 36119788
pmcid: 9420325
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.
doi: 10.1097/SLA.0b013e3181b13ca2
pubmed: 19638912
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161:584–91.
doi: 10.1016/j.surg.2016.11.014
pubmed: 28040257
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8.
doi: 10.1016/j.surg.2007.05.005
pubmed: 17981197
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20–5.
doi: 10.1016/j.surg.2007.02.001
pubmed: 17629996
Shi Y, Jin J, Qiu W, Weng Y, Wang J, Zhao S, et al. Short-term outcomes after robot-assisted vs open pancreaticoduodenectomy after the learning curve. JAMA Surg. 2020;155:389–94.
doi: 10.1001/jamasurg.2020.0021
pubmed: 32129815
Liu Q, Zhao Z, Zhang X, Wang W, Han B, Chen X, et al. Perioperative and oncological outcomes of robotic versus open pancreaticoduodenectomy in low-risk surgical candidates: a multicenter propensity score-matched study. Ann Surg. 2023;277:e864–71.
doi: 10.1097/SLA.0000000000005160
pubmed: 34417366
Guo W, Ye X, Li J, Lu S, Wang M, Wang Z, et al. Comparison of surgical outcomes among open, laparoscopic, and robotic pancreatoduodenectomy: a single-center retrospective study. BMC Surg. 2022;22:348.
doi: 10.1186/s12893-022-01797-4
pubmed: 36138358
pmcid: 9494911
Nassour I, Choti MA, Porembka MR, Yopp AC, Wang SC, Polanco PM. Robotic-assisted versus laparoscopic pancreaticoduodenectomy: oncological outcomes. Surg Endosc. 2018;32:2907–13.
doi: 10.1007/s00464-017-6002-2
pubmed: 29280014
Khachfe HH, Nassour I, Hammad AY, Hodges JC, AlMasri S, Liu H, et al. Robotic pancreaticoduodenectomy: increased adoption and improved outcomes: is laparoscopy still justified? Ann Surg. 2023;278:e563–9.
doi: 10.1097/SLA.0000000000005687
pubmed: 36000753
Vining CC, Kuchta K, Berger Y, Paterakos P, Schuitevoerder D, Roggin KK, et al. Robotic pancreaticoduodenectomy decreases the risk of clinically relevant post-operative pancreatic fistula: a propensity score matched NSQIP analysis. HPB (Oxford). 2021;23:367–78.
doi: 10.1016/j.hpb.2020.07.004
pubmed: 32811765
Cai J, Ramanathan R, Zenati MS, Al Abbas A, Hogg ME, Zeh HJ, et al. Robotic pancreaticoduodenectomy is associated with decreased clinically relevant pancreatic fistulas: a propensity-matched analysis. J Gastrointest Surg. 2020;24:1111–8.
doi: 10.1007/s11605-019-04274-1
pubmed: 31267434
Kim H, Choi SH, Jang JY, Choi M, Lee JH, Kang CM. Multicenter comparison of totally laparoscopic and totally robotic pancreaticoduodenectomy: propensity score and learning curve-matching analyses. J Hepatobiliary Pancreat Sci. 2022;29:311–21.
doi: 10.1002/jhbp.1078
pubmed: 34773395
Jang JY, Kang CM, Kim H, Choi M, Lee JH, Choi SH. Which one is better? Laparoscopic versus robotic reconstruction in the remnant soft pancreas with a small pancreatic duct following pancreaticoduodenectomy: a multicenter study with propensity score matching analysis. Surg Endosc. 2023;37:4028–39.
doi: 10.1007/s00464-022-09602-2
pubmed: 36097095
Xu J, Ji SR, Zhang B, Ni QX, Yu XJ. Strategies for pancreatic anastomosis after pancreaticoduodenectomy: what really matters? Hepatobil Pancreat Dis Int. 2018;17:22–6.
doi: 10.1016/j.hbpd.2018.01.012
Petrova E, Suurmeijer JA, Mackay TM, Bolm L, Lapshyn H, Honselmann KC, et al. Outcome of pancreatic anastomoses during pancreatoduodenectomy in two national audits. Surgery. 2021;170:1799–806.
doi: 10.1016/j.surg.2021.06.042
pubmed: 34373107
Qin R, Kendrick ML, Wolfgang CL, Edil BH, Palanivelu C, Parks RW, et al. International expert consensus on laparoscopic pancreaticoduodenectomy. Hepatobil Surg Nutr. 2020;9:464–83.
doi: 10.21037/hbsn-20-446
Li D, Du C, Zhao W, Li S, Lv H, Wang W. Application of single-layer continuous duct-to-mucosa pancreaticojejunostomy with two figure-of-eight sutures in total laparoscopic pancreaticoduodenectomy. Langenbecks Arch Surg. 2023;408:434.
doi: 10.1007/s00423-023-03155-1
pubmed: 37949977
Sun Y, Yu XF, Yao H, Xu S, Ma YQ, Chai C. Safety and feasibility of modified duct-to-mucosa pancreaticojejunostomy during pancreatoduodenectomy: a retrospective cohort study. World J Gastrointest Surg. 2023;15:1901–9.
doi: 10.4240/wjgs.v15.i9.1901
pubmed: 37901736
pmcid: 10600778
Zhang T, Zhao ZM, Gao YX, Lau WY, Liu R. The learning curve for a surgeon in robot-assisted laparoscopic pancreaticoduodenectomy: a retrospective study in a high-volume pancreatic center. Surg Endosc. 2019;33:2927–33.
doi: 10.1007/s00464-018-6595-0
pubmed: 30483970
Chan KS, Wang ZK, Syn N, Goh BKP. Learning curve of laparoscopic and robotic pancreas resections: a systematic review. Surgery. 2021;170:194–206.
doi: 10.1016/j.surg.2020.11.046
pubmed: 33541746