Aimin Li1,2*, Junzhou Chen1#, Jin Lv1#, Xiang Liu1 and Quanda Liu1*
1Department of Hepatobiliary Surgery, PLA Rocket Force Characteristic Medical Center, Beijing, China
2Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, China
#These authors contributed equally to this work
Introduction: Robotic Pancreaticoduodenectomy (RPD) is extremely challenging owing to its technical difficulties and high risks of complications, especially postoperative pancreatic fistula. The Pancreaticojejunostomy (PJs) is the crucial procedure in PD. Given this, we sought to develop a new and safe PJs named as se-drained pancreaticojejunostomy to reduce postoperative pancreatic fistula. We report a mini review on the potentiality of reducing postoperative pancreatic fistula of the sedrained pancreaticojejunostomy in three cases of robotic pancreaticoduodenectomy. Methods: Patients with periampullary lesions underwent a modified pancreaticojejunostomy in total robotic pancreaticoduodenectomy under the da Vinci S robotic surgical system. A tube was inserted into the pancreatic duct as a stent; pancreatic fluid was drained externally through the jejunal loop by using the stent-like tube with an interval of approximately 0.5 cm maintained to separate the jejunal loop and the pancreatic stump. We called this separately drained pancreaticojejunostomy as se-drained pancreaticojejunostomy. The external drainage tube was removed about three months after the operation, and the pancreatic fluid was discharged into the jejunum through the organically formed canal between the pancreatic stump and the jejunal loop. The main observable variables are 90-day morbidity, mortality, readmission and reoperation. The long-term follow-up was performed and the Disease-Free Survival (DFS) and the postoperative Overall Survival time (OS) was calculated. Results: All the three patients recovered uneventfully without reoperation or any serious complication. The patient in case 1 was diagnosed lung metastasis 5 months and dead 11 months after surgery due to lung metastasis and pneumonia. The patient in case 2 was diagnosed liver metastasis 10 months after surgery and loss of follow-up after then. The patient in case 3 is still alive and followed up for more than 82 months, who was diagnosed liver metastasis 68 months after surgery. Conclusion: The se-drained pancreaticojejunostomy can greatly simplify the procedure of pancreaticojejunostomy and reduce the risk of postoperative pancreatic fistula and reoperation.
Li A, Chen J, Lv J, Liu X, Liu Q. Modified Pancreatojejunostomy in Robotic Pancreaticoduodenectomy for Patients with High Risk of Postoperative Pancreatic Fistula. Clin Surg. 2020; 5: 2876..