Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2025; 17(3): 102428
Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.102428
Clinical outcomes of interlocking main pancreatic duct-jejunal internal bridge drainage in middle pancreatectomy: A comparative study
Xin-Yan Lu, Xiao-Dong Tan
Xin-Yan Lu, Xiao-Dong Tan, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Lu XY and Tan XD conceptualized and designed this study; Lu XY contributed to data acquisition, data analysis, data interpretation, and manuscript drafting; Tan XD revised the manuscript critically for important intellectual content and supervised the study; and all authors read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the institutional review board of the Shengjing Hospital of China Medical University (No. 2024PS903K) and conducted in accordance with the Declaration of Helsinki.
Informed consent statement: Written informed consent was waived by the institutional review board due to the retrospective nature of this study and the use of de-identified retrospective data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Dong Tan, MD, Department of General Surgery, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. tanxdcmu@163.com
Received: October 31, 2024
Revised: December 1, 2024
Accepted: January 16, 2025
Published online: March 27, 2025
Processing time: 115 Days and 18.4 Hours
Abstract
BACKGROUND

Middle pancreatectomy (MP) is a surgical procedure that removes non-invasive lesions in the pancreatic neck and body, allowing for the preservation of pancreatic function. However, MP is associated with a higher risk of postoperative complications, and there’s no clear consensus on which anastomotic method is preferable. In recent years, our team has developed a new method called interlocking main pancreatic duct-jejunal (IMPD-J) internal bridge drainage to MP.

AIM

To compare perioperative and postoperative outcomes in patients who underwent IMPD-J bridge drainage and those underwent traditional duct-to-mucosa pancreatojejunostomy.

METHODS

Patients who underwent MP in our hospital between October 1, 2011 and July 31, 2023 were enrolled in this study. Patients were divided into two groups based on their pancreatojejunostomy technique: IMPD-J bridge drainage group and duct-to-mucosa pancreatojejunostomy group. Demographic data (age, gender, body mass index, hypertension, diabetes, etc.) and perioperative indicators [operation time, intraoperative bleeding, clinically relevant postoperative pancreatic fistula (CR-POPF), delayed gastric emptying, etc.] were recorded and analyzed statistically.

RESULTS

A total of 53 patients were enrolled in this study, including 23 in the IMPD-J Bridge Drainage group and 30 in the traditional duct-to-mucosa pancreatojejunostomy group. There were no significant differences in demographic or preoperative characteristics between the groups. Compared to traditional duct-to-mucosa pancreaticojejunostomy, IMPD-J bridge drainage had a significant shorter operation time (4.3 ± 1.3 hours vs 5.8 ± 1.8 hours, P = 0.002), nasogastric tube retention days (5.3 ± 1.7 days vs 6.5 ± 2.0 days, P = 0.031), lower incidence of delayed gastric emptying (8.7% vs 36.7%, P = 0.019), and lower incidence of CR-POPF (39.1% vs 70.0%, P = 0.025). Multivariate logistic regression analysis showed that pancreaticojejunostomy type (odds ratio = 4.219, 95% confidence interval = 1.238-14.379, P = 0.021) and plasma prealbumin (odds ratio = 1.132, 95% confidence interval = 1.001-1.281, P = 0.049) were independent risk factor for CR-POPF. In IMPD-J bridge drainage group, only one patient experienced recurrent pancreatitis due to the large diameter of the silicone tube and had it removed six months after surgery.

CONCLUSION

Compared to traditional duct-to-mucosa pancreatojejunostomy, IMPD-J bridge drainage has the advantages of simplicity and fewer perioperative complications, with favorable long-term outcomes.

Keywords: Middle pancreatectomy; Pancreaticojejunostomy; Duct-to-mucosa pancreaticojejunostomy; Clinically relevant postoperative pancreatic fistula; Delayed gastric emptying; Perioperative and postoperative complications

Core Tip: Interlocking main pancreatic duct-jejunal bridge drainage emerges as a promising technique for middle pancreatectomy, offering shorter operation time, reduced risk of clinically relevant postoperative pancreatic fistula and delayed gastric emptying, and favorable long-term safety. Compared to traditional duct-to-mucosa pancreatojejunostomy, interlocking main pancreatic duct-jejunal bridge drainage demonstrates simplicity and fewer perioperative complications, suggesting its potential as a preferred method in middle pancreatectomy procedures.