Efficacy of Chen's pancreaticojejunostomy for patients with soft pancreatic texture and small main pancreatic duct in laparoscopic pancreaticoduodenectomy.

Background: Pancreaticojejunostomy (PJ) is the key step in laparoscopic pancreaticoduodenectomy (LPD), the quality of which directly affects the incidence of postoperative pancreatic fistula (POPF). Soft pancreatic texture and a small main pancreatic duct (MPD) are risk factors for POPF, which also increase surgeons' difficulty with PJ. Chen's pancreaticojejunostomy is simple, feasible, and reproducible. This study aims to evaluate the clinical effects of Chen's pancreaticojejunostomy for patients with soft pancreas texture and a small MPD in LPD.

Methods: The clinical data of 112 patients who underwent LPD with Chen's pancreaticojejunostomy in Xiangyang Central Hospital from February 2018 to December 2023 were analyzed retrospectively. Summarize and evaluate the critical clinical indicators and postoperative complications during the perioperative period.

Results: All 112 patients successfully underwent LPD. The median operation time was 300 min, the median PJ time was 27 min, and the median intraoperative blood loss was 100 ml. 8 patients (7.1%) had POPF, all of which had grade B POPF, and no grade C POPF occurred. Postoperative mortality was 1.8% (2/112) within 90 days, and no patient died due to POPF. Among 45 cases (40.2%) with soft pancreatic texture, five patients (11.1%) developed POPF. Among 41 patients (36.6%) with a diameter of MPD ≤ 3 mm, four patients (9.8%) developed POPF. The texture of the pancreas and the diameter of MPD did not affect postoperative complications (P > 0.05).

Conclusions: Chen's pancreaticojejunostomy is simple, safe and reliable, which is suitable for the condition of soft pancreatic texture or the small MPD.