Top

Published in:

02-08-2023 | Pancreaticojejunostomy | Dynamic Manuscript

End-to-end invaginated pancreaticojejunostomy during minimally invasive pancreatoduodenectomy: technical description and single center experience

Authors: Manuel Barberio, Antonio Milizia, Margherita Pizzicannella, Alfonso Lapergola, Vittoria Barbieri, Sara Benedicenti, Francesco Rubichi, Amedeo Altamura, Gloria Giaracuni, Stefania Citiso, Maria Teresa Mita, Massimo Giuseppe Viola

Published in: Surgical Endoscopy | Issue 9/2023

Abstract

Background

Remarkable progress has been made in pancreatic surgery over the last decades with the introduction of minimally invasive techniques. Minimally invasive pancreatoduodenectomy (MIPD) remains one of the most challenging operations in abdominal surgery and it is performed in a few centers worldwide. The treatment of the pancreatic stump is a crucial step of this operation; however, the best strategy to perform pancreatic anastomosis is still debated. In this article, we describe the technical details of our original technique of modified minimally invasive end-to-end invaginated pancreaticojejunostomy (EIPJ) using video footage.

Methods

In the current study, we retrospectively analyzed a pilot series of 67 consecutive cases of minimally invasive (7 robotic/60 fully laparoscopic) MIPD operated on at the General Surgery Department of the Panico Hospital, Tricase (Italy) between March 2017 and October 2022.The reconstruction phase involved an EIPJ, tailored using an intra-ductal anastomotic plastic stent. The aim of this study was to describe the technique and evaluate the short-term outcomes of patients undergoing MIPD with EIPJ.

Results

The mean operative time to perform the EIPJ was 21.57 ± 3.32 min. Seven patients (10.5%) developed biochemical leaks and 13 (19.4%) developed clinically relevant pancreatic fistulas (grade B or C according to the definition of the International Study Group on Pancreatic Surgery).

Conclusion

The early results confirm that this anastomosis is safe, easy to perform, and effective in the hands of hepatobiliopancreatic (HBP) surgeons with experience in minimally invasive surgery.

Available only for authorised users

Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410CrossRefPubMed

Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784CrossRefPubMed

Van Hilst J, de Rooij T, Bosscha K, Brinkman DJ, van Dieren S, Dijkgraaf MG, Gerhards MF, de Hingh IH, Karsten TM, Lips DJ (2019) Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol 4:199–207CrossRefPubMed

Croome KP, Farnell MB, Que FG, Reid-Lombardo K, Truty MJ, Nagorney DM, Kendrick ML (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg 260:633–640CrossRefPubMed

Kabir T, Tan HL, Syn NL, Wu EJ, Kam JH, Goh BK (2021) Outcomes of laparoscopic, robotic, and open pancreatoduodenectomy: a network meta-analysis of randomized controlled trials and propensity-score matched studies. Surgery. https://doi.org/10.1016/j.surg.2021.07.020CrossRefPubMed

Da Dong X, Felsenreich DM, Gogna S, Rojas A, Zhang E, Dong M, Azim A, Gachabayov M (2021) Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis. Sci Rep 11:1–20

Klompmaker S, van Hilst J, Wellner UF, Busch OR, Coratti A, D’Hondt M, Dokmak S, Festen S, Kerem M, Khatkov I (2020) Outcomes after minimally-invasive versus open pancreatoduodenectomy: a pan-European propensity score matched study. Ann Surg 271:356–363CrossRefPubMed

Bassi C, Marchegiani G, Dervenis C, Sarr M, Hilal MA, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591CrossRefPubMed

Mungroop TH, Klompmaker S, Wellner UF, Steyerberg EW, Coratti A, D’Hondt M, de Pastena M, Dokmak S, Khatov I, Saint-Marc O (2021) Updated alternative fistula risk score (ua-FRS) to include minimally invasive pancreatoduodenectomy: pan-European validation. Ann Surg 273:334–340CrossRefPubMed

10.

Olakowski M, Grudzińska E, Mrowiec S (2020) Pancreaticojejunostomy—a review of modern techniques. Langenbecks Arch Surg 405:13–22CrossRefPubMedPubMedCentral

11.

Ielpo B, Anselmo A, Koh Y, Burdio F, De Blasi V, Sanchez-Velazquez P, Azagra JS, Huscher C, Giuliani A, Pellino G (2023) Minimally invasive pancreatic anastomosis after pancreaticoduodenectomy: multi-institutional step by step video description of the technique. Updates Surg 75(1):255–259. https://doi.org/10.1007/s13304-022-01389-0CrossRefPubMed

12.

Shrikhande SV, Sivasanker M, Vollmer CM, Friess H, Besselink MG, Fingerhut A, Yeo CJ, Fernandez-delCastillo C, Dervenis C, Halloran C (2017) Pancreatic anastomosis after pancreatoduodenectomy: a position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 161:1221–1234CrossRefPubMed

13.

Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768CrossRefPubMed

14.

Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD, De Santibañes E, Pekolj J, Slankamenac K, Bassi C (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefPubMed

15.

Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, Talamini G, Pederzoli P (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252:207–214CrossRefPubMed

16.

Schuh F, Mihaljevic AL, Probst P, Trudeau MT, Müller PC, Marchegiani G, Besselink MG, Uzunoglu F, Izbicki JR, Falconi M et al (2023) A simple classification of pancreatic duct size and texture predicts postoperative pancreatic fistula: a classification of the International Study Group of Pancreatic Surgery (ISGPS). Ann Surg 277(3):e597–e608. https://doi.org/10.1097/SLA.0000000000004855CrossRefPubMed

17.

Andrianello S, Marchegiani G, Malleo G, Masini G, Balduzzi A, Paiella S, Esposito A, Landoni L, Casetti L, Tuveri M, Salvia R, Bassi C (2020) Pancreaticojejunostomy with externalized stent vs Pancreaticogastrostomy with externalized stent for patients with high-risk pancreatic anastomosis: a single-center, phase 3, randomized clinical trial. JAMA Surg 155:313–321CrossRefPubMed

18.

Peng SY, Mou YP, Liu YB, Su Y, Peng CH, Cai XJ, Wu YL, Zhou LH (2003) Binding pancreaticojejunostomy: 150 consecutive cases without leakage. J Gastrointest Surg 7:898–900CrossRefPubMed

19.

Shrikhande SV, Sivasanker M, Vollmer CM, Friess H, Besselink MG, Fingerhut A, Yeo CJ, Fernandez-delCastillo C, Dervenis C, Halloran C, Gouma DJ, Radenkovic D, Asbun HJ, Neoptolemos JP, Izbicki JR, Lillemoe KD, Conlon KC, Fernandez-Cruz L, Montorsi M, Bockhorn M, Adham M, Charnley R, Carter R, Hackert T, Hartwig W, Miao Y, Sarr M, Bassi C, Büchler MW (2017) Pancreatic anastomosis after pancreatoduodenectomy: a position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 161:1221–1234CrossRefPubMed

20.

Müssle B, Zühlke L, Wierick A, Sturm D, Grählert X, Distler M, Rahbari NN, Weitz J, Welsch T (2018) Pancreatoduodenectomy with or without prophylactic falciform ligament wrap around the gastroduodenal artery stump for prevention of pancreatectomy hemorrhage. Trials 19:222CrossRefPubMedPubMedCentral

21.

Wiggins T, Majid MS, Markar SR, Loy J, Agrawal S, Koak Y (2020) Benefits of barbed suture utilisation in gastrointestinal anastomosis: a systematic review and meta-analysis. Ann Royal College Surg Engl 102:153–159CrossRef

22.

Velotti N, Manigrasso M, Di Lauro K, Vertaldi S, Anoldo P, Vitiello A, Milone F, Musella M, De Palma GD, Milone M (2021) Barbed suture in gastro-intestinal surgery: a review with a meta-analysis. The Surgeon. https://doi.org/10.1016/j.surge.2021.02.011CrossRefPubMed

23.

Azagra JS, Makkai-Popa S-T, Pascotto B, Arru L, De Blasi V, Ramia JM, Ibanez-Aguirre FJ, Goergen M (2020) Laparoscopic pancreaticojejunal anastomosis using knotless barbed absorbable sutures are simple, safe and effective: an experience with 34 procedures. Laparosc Surg 4:27CrossRef

Title: End-to-end invaginated pancreaticojejunostomy during minimally invasive pancreatoduodenectomy: technical description and single center experience
Authors: Manuel Barberio
Antonio Milizia
Margherita Pizzicannella
Alfonso Lapergola
Vittoria Barbieri
Sara Benedicenti
Francesco Rubichi
Amedeo Altamura
Gloria Giaracuni
Stefania Citiso
Maria Teresa Mita
Massimo Giuseppe Viola
Publication date: 02-08-2023
Publisher: Springer US
Keywords: Pancreaticojejunostomy
Pancreatoduodenostomy
Pancreatoduodenostomy
Pancreatic Surgery
Pancreatic Surgery
Published in: Surgical Endoscopy / Issue 9/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-023-10316-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

End-to-end invaginated pancreaticojejunostomy during minimally invasive pancreatoduodenectomy: technical description and single center experience

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2023

Need for frequent dilations after magnetic sphincter augmentation: an assessment of associated factors and outcomes

Components of high-resolution manometry that change surgical decisions

Safety and efficacy of robotic-assisted versus laparoscopic distal gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer

Single-staged retromuscular abdominal wall reconstruction with mesh at the time of ostomy reversal: are we crossing the line? An ACHQC Analysis

Development of a deep learning model for safe direct optical trocar insertion in minimally invasive surgery: an innovative method to prevent trocar injuries

Evaluation of the SafeHeal Colovac+ anastomosis protection device after low anterior resection for rectal cancer: the safe anastomosis feasibility evaluation (SAFE) 2019 trial