Kim Eun Young, Hong Tae Ho
Department of Hepato-biliary and Pancreas Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea , Seoul, Republic of Korea.
J Laparoendosc Adv Surg Tech A. 2016 Feb;26(2):133-9. doi: 10.1089/lap.2015.0427. Epub 2015 Dec 30.
Laparoscopic pancreaticoduodenectomy is advantageous as a minimally invasive surgery, but performing the complicated anastomosis is technically difficult. Herein, we present our experiences with total laparoscopic pancreaticoduodenectomy (TLPD) using a unique anastomosis technique, that is, pancreaticojejunostomy using only two transpancreatic sutures with buttresses method (PJt).
From September 2013 to March 2015, 12 TLPDs using PJt for periampullary tumors were performed. In each case, the pancreaticoenteric anastomosis was performed using the PJt technique, a modification of invaginated, end-to-end pancreaticojejunostomy. A pair of transpancreatic sutures were placed on the upper and lower borders of the implanted pancreas through the jejunal limb covering the pancreas stump, and four buttresses were used to reinforce the anastomosis. All medical records and follow-up data were reviewed and analyzed with regard to surgical outcomes, and the results were compared with previously published reports on TLPD.
The mean age of the patients was 64.3 ± 12.3 years, and all were diagnosed with pancreas head cancer except 5 patients (4 patients had ampulla of Vater cancer, and the other had chronic pancreatitis). The mean estimated blood loss was 118 ± 57 mL, and the mean hospital stay was 12.5 ± 4.5 days. The mean operative time was 411.6 ± 59.2 minutes, and the pancreas anastomosis time was 20.1 ± 4.8 minutes without any evidence of anastomosis-related complications.
Our novel technique of PJt is a simple, easy, and feasible method for TLPD with the possibility of reducing the burden to the operator and acquiring secure anastomosis.
腹腔镜胰十二指肠切除术作为一种微创手术具有优势，但进行复杂的吻合术在技术上具有挑战性。在此，我们介绍我们使用独特吻合技术进行全腹腔镜胰十二指肠切除术（TLPD）的经验，即仅使用两根经胰腺缝线加支撑法的胰空肠吻合术（PJt）。
2013年9月至2015年3月，对12例使用PJt治疗壶腹周围肿瘤的TLPD患者进行了手术。在每例手术中，采用PJt技术进行胰肠吻合，这是一种改良的套入式端端胰空肠吻合术。通过覆盖胰腺残端的空肠袢在植入胰腺的上下边缘放置一对经胰腺缝线，并使用四个支撑物加强吻合。对所有病历和随访数据进行回顾和分析以评估手术结果，并将结果与先前发表的关于TLPD的报告进行比较。
患者的平均年龄为64.3±12.3岁，除5例患者外均诊断为胰头癌（4例为 Vater壶腹癌，另1例为慢性胰腺炎）。平均估计失血量为118±57 mL，平均住院时间为12.5±4.5天。平均手术时间为411.6±59.2分钟，胰腺吻合时间为20.1±4.8分钟，未出现任何与吻合相关的并发症。
我们新颖的PJt技术是一种简单、易行且可行的TLPD方法，有可能减轻术者负担并实现安全吻合。
