Application of an innovative embedded parallel pancreaticojejunostomy technique in laparoscopic pancreaticoduodenectomy.

Abstract

Objective: To investigate the clinical value of an innovative embedded parallel pancreaticojejunostomy technique for laparoscopic pancreaticoduodenectomy.

Methods: We retrospectively analyzed the clinical data of 108 patients who underwent successful laparoscopic pancreaticoduodenectomy at The Affiliated Lihuili Hospital of Ningbo University, from January 2016 to July 2025. Patients were divided according to the type of pancreaticojejunostomy: the experimental group (n = 57) underwent an embedded parallel pancreaticojejunostomy, while the control group (n = 51) underwent duct-to-mucosa pancreaticojejunostomy. The baseline characteristics, tumor features, intraoperative and postoperative conditions, and complications were compared between the two groups. And through a multivariate logistic regression model, the independent effects of the surgical groups (experimental group, control group) were evaluated.

Results: The incidence of grade B/C postoperative pancreatic fistula in the experimental group (5.3%) was significantly lower than that of the control group (19.6%), and the difference was statistically significant (P < 0.05). The pancreaticojejunostomy time (21.33 ± 2.73 min), postoperative drainage tube removal time (14.00, 10.00-17.50 days), and postoperative hospitalization (16.00, 12.50-21.00 days) in the experimental group were all significantly shorter than those in the control group (31.43 ± 2.30 min; 17.00, 11.00-28.00 days; 20.00, 13.00-29.00 days, respectively; all P < 0.05). There were no significant differences (P > 0.05) between the two groups in age, American Society of Anesthesiologists, Fistula Risk Score, main pancreatic duct diameter, sex, body mass index, pathological type, maximal tumor diameter, pancreatic texture, intraoperative margin status, lymph node metastasis, operative time, intraoperative blood loss, delayed gastric emptying, or postoperative bleeding. And the intervention measure (experimental group, control group) was independent protective factors for reducing postoperative pancreatic fistula (OR=0.19, 95% Cl, 0.05-0.75, P < 0.05).

Conclusion: The embedded parallel pancreaticojejunostomy technique can effectively reduce the incidence of postoperative pancreatic fistula and shorten pancreaticojejunostomy time. This technique is a simple and effective new method for pancreaticojejunostomy and is worthy of application in laparoscopic pancreaticoduodenectomy.