Pancreaticogastrostomy by the Twin U-stitch Method in Totally Laparoscopic Pancreaticoduodenectomy

Abstract

Introduction : We first in Japan started performing pancreaticogastrostomy as pancreatico-enteric reconstruction after open pancreaticoduodenectomy in Japan, and it has also been applied to laparoscopic pancreaticogastrostomy reconstruction by the twin U-stitch method in laparoscopic pancreaticoduodenectomy. Methods : Ten cases in which the twin U-stitch method was used between October 2021 and May 2023, after the introduction of totally laparoscopic pancreaticoduodenectomy, were retrospectively reviewed. Patient attributes, surgical outcomes, postoperative course, and complications were investigated. Results : The patients were 5 men and 5 women aged 36-72 years (mean age 56 years) with a body mass index (BMI) of 15.9-29.6 (mean BMI 20.1) kg/m². The disease was malignant in 3 cases and borderline malignant in 7. Operating time was 361-570 (mean 436) min, and blood loss was 50-650 (mean 100) ml. Six patients had a soft pancreas, and the time required for pancreaticogastrostomy was 45-90 (mean 55) min. There were two cases of postoperative ISGPS Grade B or worse pancreatic juice leakage. Discussion and Conclusions : The outcomes of laparoscopic pancreaticogastrostomy in totally laparoscopic pancreaticoduodenectomy revealed to be satisfactory. The twin U-stitch method is a useful technique in pancreaticogastrostomy especially in totally laparoscopic pancreaticoduodenectomy.