Application Of Modified Single-layer Pancreaticointestinal Anastomosis In Laparoscopic Pancreaticoduodenectomy

Objective:By comparing the incidence of pancreatic fistula and other complications after traditional end-lateral pancreaticoduodenectomy with modified single-layer pancreaticoduodenectomy(hereinafter referred to as:single-layer pancreaticoduodenectomy),the feasibility and safety of single-layerpancreaticoduodenectomyinlaparoscopic pancreaticoduodenectomy(LPD)are studied and discussed to provide a reference for the clinical application of this procedure.The feasibility and safety of single-layer pancreaticoduodenectomy in laparoscopic pancreaticoduodenectomy(LPD)are studied and discussed to provide a reference for the application of this procedure in clinical work.Methods:The clinical data of a total of 74 patients who underwent LPD for various benign and malignant diseases admitted to the hepatobiliary-pancreatic(minimally invasive)surgery department of the Cancer Hospital of Cangzhou City from January 2018 to December 2022were retrospectively analyzed,and all were operated by the same attending surgeon for surgery-related operations.Different pancreatic-intestinal anastomoses were used to differentiate the patients,among which 35 patients underwent traditional end-lateral sleeve pancreatic-intestinal anastomosis(traditional group)and 39 patients underwent modified single-layer pancreatic-intestinal anastomosis(modified group),and external drainage of pancreatic duct was used in both groups.The main observations were to compare the basic preoperative conditions,overall operative time,intraoperative pancreatic-intestinal anastomosis time,intraoperative bleeding,postoperative complications(pancreatic fistula,biliary fistula,postoperative bleeding,abdominal infection,gastric emptying disorder,etc.),postoperative secondary surgery rate,mortality rate,postoperative hospitalization time,and overall hospitalization cost between the two groups.Among them,after the normal distribution test,the measurement data conforming to the normal distribution were expressed as the mean±standard deviation,and the two independent samples t-test was used after verifying the chi-square;the measurement data not conforming to the normal distribution were expressed as the median and quartiles,and the nonparametric rank sum test was used.For the count data,theX~2test or the continuous correctedX~2test was used.All the above results were considered statistically significant at P<0.05.Results:In the modified group,there were 39 patients,25 males and 14 females,aged 41-74 years,mean age 60.97±8.23 years,mean body mass index(BMI)23.14±2.98 Kg/m~2,12 patients underwent preoperative yellowing reduction(PTCD,ERCP,etc.),mean intraoperative bleeding Postoperatively,8 patients developed pancreatic fistula,3 patients developed biliary fistula,3 patients developed postoperative bleeding,8 patients developed abdominal infection,and 3 patients developed gastric emptying disorder.One patient had an acute asthma attack on the 7th postoperative day,resulting in respiratory arrest,and later died after resuscitation,but the rest were discharged after postoperative symptomatic treatment,with an average postoperative hospitalization time of 22.33±8.72 d.There were 35 patients in the traditional group,including 22 males and 13 females,aged 41-75 years,with an average age of 61.26±8.85 years and an average BMI of 24.15±2.68Kg/m~2,8 patients underwent preoperative yellowing reduction(PTCD,ERCP and other modalities),mean intraoperative bleeding 508.57±165.16ml,overall operative time 6.18±0.53 h.Postoperatively,8 patients developed pancreatic fistula,1 patient developed biliary fistula,2 patients developed postoperative bleeding,9 patients developed abdominal infection,and 2 patients developed gastric Two patients had impaired gastric emptying.All patients were discharged after postoperative symptomatic treatment and there were no postoperative deaths,and the average postoperative hospitalization time was 24.80±7.75 d.No patients in both groups required secondary surgery after surgery.The differences in the general preoperative basic conditions,overall operating time,intraoperative bleeding,postoperative complications(pancreatic fistula,biliary fistula,postoperative bleeding,abdominal infection,gastric emptying disorder,etc.),postoperative secondary surgery rate,mortality rate,postoperative hospitalization time,and overall hospitalization cost between the two groups were not statistically significant after comparison(P>0.05).Regarding the mean pancreatic-enteric anastomosis time,it was 23.77±1.46 min in the modified group and 29.66±2.65 min in the conventional group,and the mean pancreatic-enteric anastomosis time was significantly shorter in the modified group compared with the conventional group,and the difference was statistically significant(P<0.05).Conclusions:The single-layer pancreatic-intestinal anastomosis in the modified group has the advantages of simplifying the anastomosis steps,reducing the difficulty of operation,easy to master,shortening the pancreatic-intestinal anastomosis time,and not increasing the incidence of various postoperative complications compared with the end-lateral sleeve pancreatic-intestinal anastomosis in the traditional group,and its safety and feasibility have also been proved in clinical practice.