The Strategy and Technique of Laparscopic Pancreaticjejunostomy

Weiwei Jin, MS, Yiping Mou, MD, FACS. Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.

Introduction: The aim of this study was to introduce how to perform a safe laparoscopic pancreaticojejunostomy.

Methods: Laparoscopic pancreaticojejunostomy is performed with the end-to-side anastomosis for the pancreatic duct smaller than 2mm and the duct-to-mucosa anastomosis with stent for the pancreatic duct ranging from 2mm to 5mm, and the duct-to-mucosa ananstomosis without stent for pancreatic duct greater than 5mm. The anastomosis methods, the outcomes of the procedure about the laparoscopic pancreaticojejunostomy in 21 consecutive patients were analyzed between January 2010 and September 2013.

Results: 10 patients underwent laparoscopic central pancreatectomy and the others were with laparoscopic pancreaticoduodenectomy. In all 21 laparoscopic pancreaticojejunostomy, 7 cases were performed with the procedure of the end-to-side anastomosis. Another 14 patients underwent the duct-to-mucosa anastomosis, in which group there were 4 patients of the pancreatic ducts bigger than 5mm without stents, and remaining 10 patients of the pancreatic ducts bigger than 2mm and smaller than 5mm with stents. The mean time of the end-to-side anastomosis was 40 min and the duct-to mucosa was 55 min. there was no obviously different between the operation with stent and without stent. Based on the international Study Group on Pancreatic Fistula criteria, 5 patients developed pancreatic fistula (grade A), 2 with the duct-to-mucosa anastomosis with the stent and 3 with the end-to-side anastomosis, whereas the other 16 patients did not. There was no abdominal or digestive bleeding.

Conclusion: This individual strategy for laparoscopic pancreaticojejunostomy is feasible and safe.

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