Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2023; 15(12): 2792-2798
Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2792
Novel invagination procedure for pancreaticojejunostomy using double purse string sutures: A technical note
Jun Li, He-Yuan Niu, Xing-Kai Meng
Jun Li, He-Yuan Niu, Xing-Kai Meng, Department of Hepatobiliary, Pancreatic and Splenic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010010, Inner Mongolia Autonomous Region, China
Co-first authors: Jun Li and He-Yuan Niu.
Author contributions: Meng XK and Li J contributed to the study conception and design; Niu HY and Li J wrote the manuscript; Niu HY and Li J performed data collection and illustration; Niu HY performed data analysis; all authors contributed to the article and approved the final submitted version. Niu HY and Li J contributed equally to this work as co-first authors. First, the main design of this project was completed by Meng XK and Li J, which makes our project more rigorous. Second, Niu HY and Li J contributed equal efforts throughout the research process. Finally, the choice of these researchers as co-first authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study.
Supported by Major Project Funding of the Hohhot First Hospital, No. 2022SYY (ZD) 01; The Science And Technology Million Project Joint Project In Inner Mongolia Medical University, No. YKD2020KJBW(LH)027; Natural Science Foundation of Inner Mongolia Autonomous Region, No. 2023MS08056; Breakthrough and Demonstration Promotion Of The Key Technological System For Minimally Invasive Treatment Of Biliary Tract Diseases, Inner Mongolia Autonomous Region Science and Technology Plan, No. 2022YFSH0098.
Institutional review board statement: This study was reviewed and approved by the Inner Mongolia Medical University Affiliated Hospital (Approval number: KY.2022028).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at mxk6788@126.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xing-Kai Meng, MD, Chief Physician, Department of Hepatobiliary, Pancreatic and Splenic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 North Road, Huimin District, Hohhot 010010, Inner Mongolia Autonomous Region, China. mxk6788@126.com
Received: October 30, 2023
Peer-review started: October 30, 2023
First decision: November 8, 2023
Revised: November 14, 2023
Accepted: December 8, 2023
Article in press: December 8, 2023
Published online: December 27, 2023
Abstract
BACKGROUND

Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD), and the choice of pancreaticojejunostomy (PJ) is considered a key factor affecting the occurrence of POPF. Numerous anastomotic methods and their modifications have been proposed, and there is no method that can completely avoid the occurrence of POPF. Based on our team’s experience in pancreatic surgery and a review of relevant literature, we describe a novel invagination procedure for PJ using double purse string sutures, which has resulted in favourable outcomes.

AIM

To describe the precise procedural steps, technical details and clinical efficacy of the novel invagination procedure for PJ.

METHODS

This study adopted a single-arm retrospective cohort study methodology, involving a total of 65 consecutive patients who underwent PD with the novel invagination procedure for PJ, including the placement of a pancreatic stent, closure of the residual pancreatic end, and two layers of purse-string suturing. Baseline data included age, sex, body mass index (BMI), pancreatic texture, pancreatic duct diameter, operation time, and blood loss. Clinical outcomes included the operation time, blood loss, and incidence of POPF, postoperative haemorrhage, delayed gastric emptying, postoperative pulmonary infection, postoperative abdominal infection, and postoperative pulmonary infection.

RESULTS

The mean age of the patients was 59.12 (± 8.08) years. Forty males and 25 females were included, and the mean BMI was 21.61 kg/m2 (± 2.74). A total of 41.53% of patients had a pancreatic duct diameter of 3 mm or less. The mean operation time was 263.83 min (± 59.46), and the mean blood loss volume was 318.4 mL (± 163.50). Following the surgical intervention, only three patients showed grade B POPF (4.62%), while no patients showed grade C POPF. Five patients (5/65, 7.69%) were diagnosed with postoperative haemorrhage. Six patients (6/65, 9.23%) experienced delayed gastric emptying. Four patients (4/65, 6.15%) developed postoperative pulmonary infection, while an equivalent number (4/65, 6.15%) exhibited postoperative abdominal infection. Additionally, two patients (2/65, 3.08%) experienced postoperative pulmonary infection.

CONCLUSION

The novel invagination technique for PJ is straightforward, yields significant outcomes, and has proven to be safe and feasible for clinical application.

Keywords: Pancreatic anastomosis, Pancreatojejunostomy, Pancreatic fistula

Core Tip: A novel invagination procedure for pancreaticojejunostomy (PJ) was proposed in this article, leading to significant improvements in outcomes. The incidence of postoperative pancreatic fistula with this method was only 4.65%. This standardized PJ method is a dependable and secure surgical technique that has high clinical significance and should be implemented widely in clinical settings.