Modified binding pancreaticogastrostomy vs modified Blumgart pancreaticojejunostomy after laparoscopic pancreaticoduodenectomy for pancreatic or periampullary tumors  

作　　者：Satyaprakash Ray Choudhury Raja Kalayarasan Senthil Gnanasekaran Biju Pottakkat 

机构地区：[1]Department of Surgical Gastroenterology,Jawaharlal Institute of Postgraduate Medical Education and Research,Puducherry 605006,India

出　　处：《World Journal of Clinical Oncology》2022年第5期366-375,共10页世界临床肿瘤学杂志（英文版）

摘　　要：BACKGROUND Laparoscopic pancreaticoenteric anastomosis is one of the technically challenging steps of minimally invasive pancreaticoduodenectomy(PD),especially during the learning curve.Despite multiple randomized controlled trials and meta-analyses,the type of pancreatico-enteric anastomosis as a risk factor for post-pancreatectomy complications is debatable.Also,the ideal technique of pancreatic reconstruction during the learning curve of laparoscopic PD has not been well studied.AIM To compare the short-term outcomes of modified binding pancreaticogastrostomy(PG)and Blumgart pancreaticojejunostomy(PJ)during learning curve of laparoscopic PD.METHODS The first 25 patients with resectable pancreatic or periampullary tumors who underwent laparoscopic PD with modified binding PG or modified Blumgart PJ between January 2015 and May 2020 were retrospectively analyzed to compare perioperative outcomes during the same learning curve.A single layer of the fullthickness purse-string suture was placed around the posterior gastrotomy in the modified binding PG.In the modified Blumgart technique,only a single transpancreatic horizontal mattress suture was placed on either side of the pancreatic duct(total two sutures)to secure the pancreatic parenchyma to the jejunum.Also,on the ventral surface,the knot is tied on the jejunal wall without going through the pancreatic parenchyma.Post pancreatectomy complications are graded as per the RESULTS During the study period,modified binding PG was performed in 27 patients and modified Blumgart PJ in 29 patients.The demographic and clinical parameters of the first 25 patients included in both groups were comparable.Lower end cholangiocarcinoma and ampullary adenocarcinoma were the primary indications for laparoscopic PD in both groups(32/50,64%).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 grou

关 键 词：PANCREATICODUODENECTOMY LAPAROSCOPY Pancreatic cancer PANCREATICOJEJUNOSTOMY NEOPLASMS TUMORS 

分 类 号：R735[医药卫生—肿瘤]