Binding and interlocking pancreaticojejunostomy vs duct to mucosa pancreaticojejunostomy: A retrospective cohort study

Abstract

BACKGROUND

Pancreatic surgery has markedly evolved during the past several years with the development of minimally invasive techniques such as laparoscopy. pancreaticojejunostomy (PJ), also known as pancreatoenterostomy, is a critical step in surgical reconstruction after pancreatic resection. However, the laparoscopic performance of PJ presents additional technical challenges, especially in achieving a secure anastomosis while preserving the integrity of pancreatic tissue.

AIM

To evaluate the effectiveness and safety of binding and interlocking PJ (BIPJ) as a novel technique in laparoscopic pancreatic surgery.

METHODS

Data of patients who underwent laparoscopic pancreatic surgery from 2018 to 2023 were obtained from the hepatobiliary and pancreatic surgery database of the Second Affiliated Hospital of Zhejiang University School of Medicine and retrospectively analyzed. According to the different PJ methods used during surgery, the patients were divided into two groups: The BIPJ group and the duct-to-mucosa PJ (DMPJ) group.

RESULTS

BIPJ was performed in 33 patients, and DMPJ was performed in 34 patients. The operative time was significantly shorter in the BIPJ group (median, 340 minutes; interquartile range, 310-350) than in the DMPJ group (median, 388 minutes; interquartile range, 341-464) (P = 0.004). No significant differences were found between the DMPJ and BIPJ groups in terms of the rates of pancreatic fistula, intra-abdominal hemorrhage, intra-abdominal abscess, postoperative biliary fistula, reoperation, or postoperative hospital stay.

CONCLUSION

The suitability of laparoscopic PJ for all pancreatic textures, ability to perform full laparoscopy, shorter operation time, and comparable safety with traditional PJ make BIPJ a promising option for both surgeons and patients.

Keywords: Pancreaticojejunostomy; Binding pancreaticojejunostomy; Pancreatic surgery; Pancreatic fistula; Duct-to-mucosa pancreaticojejunostomy

Core Tip: This study introduces binding and interlocking pancreaticojejunostomy (BIPJ) as a novel technique for pancreatic surgery, comparing it with traditional duct-to-mucosa pancreaticojejunostomy. BIPJ demonstrated a significantly shorter operative time (median 340 vs 388 minutes, P = 0.004) while maintaining comparable safety profiles, including similar rates of postoperative pancreatic fistula and other complications. The technique’s adaptability to all pancreatic textures and suitability for laparoscopy make it a promising advancement. These findings suggest that BIPJ could enhance surgical efficiency without compromising patient outcomes, warranting further prospective validation.