Technical tips on pancreatojejunostomy and gastrojejunostomy during robotic pancreatoduodenectomy with comparison between the internal and external stent for pancreatojejunostomy.

BACKGROUND

Pancreaticoduodenectomy (PD) is essential for treating periampullary lesions but is often complicated by postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE). This study presents techniques in pancreatojejunostomy (PJ) and gastrojejunostomy (GJ) during robotic PD (RPD) to achieve zero incidence of clinically relevant (CR)-POPF and DGE.

METHODS

Patients who underwent PD at The University of Tokyo from January 2020 to July 2024 were included in this study. RPD was regularly performed and standardized after January 2022. The following anastomosis techniques were used for RPD: modified Blumgart anastomosis for PJ and side-to-side GJ in a Billroth II fashion using a linear stapler and Braun anastomosis by hand. The outcomes of RPD were compared based by the PJ stent type and with those of open PD (OPD) performed for the same indication during 2020-2022.

RESULTS

Of the 34 patients, no patient developed CR-POPF, DGE, or bile leakage. One patient with fluid collection underwent radiographic drainage with the discharge amylase level unelevated. The median (range) length of hospital stay was 8 days (5-17), and none of the patients underwent a 30-day reoperation or showed a 90-day mortality. Patients with PJ short stent placement had significantly shorter median operation times (663 vs. 795 min) and median hospital stays (6.0 vs. 8.5 days) compared to those with external stents. The incidence of POPF (0 % vs. 69.2 %, P < 0.01) and DGE (0 % vs. 23.1 %, P = 0.01) was significantly lower in the RPD group than in the OPD group.

CONCLUSIONS

The described PJ and GJ techniques and evidence-based perioperative management achieved zero CR-POPF and DGE in RPD, suggesting favorable outcomes. External stents may not improve results in RPD.