Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. May 24, 2022; 13(5): 366-375
Published online May 24, 2022. doi: 10.5306/wjco.v13.i5.366
Modified binding pancreaticogastrostomy vs modified Blumgart pancreaticojejunostomy after laparoscopic pancreaticoduodenectomy for pancreatic or periampullary tumors
Satyaprakash Ray Choudhury, Raja Kalayarasan, Senthil Gnanasekaran, Biju Pottakkat
Satyaprakash Ray Choudhury, Raja Kalayarasan, Senthil Gnanasekaran, Biju Pottakkat, Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
Author contributions: Kalayarasan R conceptualized the study and performed the surgical procedures; Choudhury SR and Gnanasekaran S performed the data acquisition and wrote the first draft of the manuscript; Kalayarasan R and Pottakkat B supervised the writing, gave intellectual inputs, and critically revised the manuscript.
Institutional review board statement: The study was approved by the Institute scientific advisory committee (PGRMC 19.04.2021-18) and the Institute ethics committee (JIP/IEC/2021/0194).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of JIPMER (http://www.jipmer.edu.in study ID - JIP/IEC/2021/0194).
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
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: Raja Kalayarasan, MBBS, MCh, MS, Additional Professor, Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Room No. 5442, 4th Floor, Super Specialty Block, Puducherry 605006, India. kalayarasanraja@yahoo.com
Received: January 18, 2022
Peer-review started: January 18, 2022
First decision: February 15, 2022
Revised: February 28, 2022
Accepted: May 7, 2022
Article in press: May 7, 2022
Published online: May 24, 2022
Processing time: 125 Days and 17.2 Hours
ARTICLE HIGHLIGHTS
Research background

Complications related to pancreatico-enteric anastomosis are a significant cause of morbidity, especially during the learning curve in laparoscopic pancreaticoduodenectomy (PD). Despite multiple randomized controlled trials and meta-analyses, the type of pancreatico-enteric anastomosis [pancreaticojejunostomy (PJ) vs pancreaticogastrostomy(PG)] as a risk factor for post-pancreatectomy complications is debatable.

Research motivation

The ideal technique of pancreatic reconstruction during the learning curve of laparoscopic PD has not been well studied.

Research objectives

To compare the short-term outcomes of modified binding PG and Blumgart technique of PJ for pancreatic reconstruction in laparoscopic PD during the learning curve.

Research methods

The first 25 patients with resectable pancreatic or periampullary tumors who underwent laparoscopic PD and pancreatic reconstruction with modified binding PG or Blumgart PJ between January 2015 and May 2020 were retrospectively analyzed. A single layer of the full-thickness purse-string suture was placed around the posterior gastrotomy in the modified binding PG. In the modified Blumgart technique, a total of two transpancreatic horizontal mattress sutures were placed on either side of the pancreatic duct to secure the pancreatic parenchyma to the jejunum. Also, on the ventral surface, the knot is tied to the jejunal wall without going through the pancreatic parenchyma. Post pancreatectomy complications are graded as per the International Study Group for Pancreatic Surgery criteria and compared to evaluate perioperative outcomes during the same learning curve.

Research results

The demographic and clinical parameters of the patients included in both groups were comparable. The median operative time for pancreatic reconstruction was significantly lower in the binding PG group (42 vs 58 min, P = 0.01). The clinically relevant (Grade B/C) postoperative pancreatic fistula (POPF) was significantly more in the modified PJ group (28% vs 4%, P = 0.04). In contrast, intraluminal postpancreatectomy hemorrhage (PPH) was more in the binding PG group (32% vs 4%, P = 0.02). There was no significant difference in the incidence of delayed gastric emptying between the two groups.

Research conclusions

Modified binding PG reduces the pancreatic reconstruction time and POPF rate during the learning curve of laparoscopic PD but is associated with increased intraluminal PPH compared to PJ using the modified Blumgart technique.

Research perspectives

Modified Binding PG combined with techniques to reduce PPH like hemostatic pancreatic sutures on either side of the pancreatic duct may reduce POPF without increasing PPH during the learning curve of laparoscopic PD. A tailored pancreatic reconstruction with modified binding PG for patients with a high fistula risk score and modified Blumgart PJ for patients with low fistula risk score may be a reasonable approach during the learning curve of laparoscopic PD.