Comparison Of Two Methods Of Pancreaticojejunostomy In Laparoscopic Pancreaticoduodenectomy

Objective: Pancreaticojejunostomy is a key step in laparoscopic pancreaticoduodenectomy,which affects the occurrence of postoperative complications such as pancreatic fistula.Therefore,at present,many studies focus on the comparison of different methods of pancreaticojejunostomy.Since performing laparoscopic pancreaticoduodenectomy,our team has tried two different methods of pancreaticojejunostomy: "bing’s" duct-to-mucosa anastomosis,"simple U-shaped endto-side invagination anastomosis".By comparing the clinical outcomes of the two methods of pancreaticojejunostomy,this paper explores the better choice of laparoscopic pancreaticojejunostomy so as to provide a basis for clinical decisionmaking.Methods: Patients who underwent laparoscopic pancreaticoduodenectomy performed by our team in the Second Department of Hepatobiliary Surgery of the First Affiliated Hospital of Kunming Medical University from September 1,2018 to August31,2022 were selected as the research objects.Retrospective data collection through the case system,Including: general data before operation,time of pancreaticojejunostomy,total time of operation,intraoperative blood loss,intraoperative blood transfusion rate,postoperative pancreatic fistula,bleeding,delayed gastric emptying,incidence of complications above Clavien-Dindo grade Ⅲ,reoperation rate,30-day mortality,90-day mortality,incision infection rate and postoperative pathological data,postoperative pancreaticointestinal drainage tube extubation time,postoperative hospital stay,total hospitalization cost and so on.And use SPSS 26.0 statistical software for data analysis,When P < 0.05,the difference between the two groups was considered to be statistically significant.Results: According to the principles of inclusion and exclusion,59 patients were included in this study(N=59),including 30 patients in "bing’s" duct-to-mucosa anastomosis group(N = 30)and 29 patients in "simple U-shaped end-to-side invagination anastomosis" group(N=29).(1)Compared with the two groups,in terms of the duration of pancreaticojejunostomy,the duration of pancreaticojejunostomy in the "simple Ushaped end-to-side invagination anastomosis" group was significantly shorter than that in the "bing’s" duct-to-mucosa anastomosis group(31.14 ± 3.13 min Vs 41.17 ± 5.11 min,P<0.05).(2)In terms of the incidence of grade B/C pancreatic leakage after operation,there were 4 patients with grade B pancreatic fistula and 1 patient with grade C pancreatic fistula in the "bing’s" duct-to-mucosa anastomosis group.The incidence of postoperative grade B/C pancreatic fistula was 16.7%.In the "simple U-shaped end-toside invagination anastomosis" group,there were 3 patients with grade B pancreatic fistula and 1 patient with grade C pancreatic fistula.the incidence of grade B/C pancreatic fistula was 13.8%.There was no significant difference in the incidence of grade B/C pancreatic fistula between the two groups(P > 0.05).(3)In terms of the incidence of postoperative bleeding and delayed gastric emptying,in the "bing’s" duct-to-mucosa anastomosis group,there were 4 patients(13.3%)with grade B/C postoperative bleeding and 4 patients(13.3%)with grade B/C delayed gastric emptying.in the "simple U-shaped end-to-side invagination anastomosis" group,there were 7 patients(24.1%)with grade B/C postoperative bleeding and 5 patients(17.2%)with grade B/C delayed gastric emptying.Although there was a higher trend of postoperative bleeding and delayed gastric emptying in the "simple U-shaped end-to-side invagination anastomosis" group,there was no significant difference between the two groups(P > 0.05).(4)In terms of other postoperative complications,the incidence of complications above Clavien-Dindo grade Ⅲ,reoperation rate,30-day mortality,90-day mortality and incision infection rate in "bing’s" duct-to-mucosa anastomosis group were 6.7%,3.3%,0.0%,3.3% and 3.3%,The incidence of complications above grade III,reoperation rate,30-day mortality,90-day mortality and incision infection rate in "simple U-shaped end-to-side invagination anastomosis" group were 13.8%,3.4%,3.4%,0.0% and 3.4%.There was no significant difference between the two groups(P >0.05).In addition,there was no significant difference in other postoperative indexes such as extubation time of pancreaticojejunal drainage tube,postoperative hospital stay and total hospitalization cost between the two groups(P > 0.05).Conclusion: Based on the current limited sample study data,we can conclude that our team’s improved "simple U-shaped end-to-side invagination anastomosis" and "bing’s" duct-to-mucosa anastomosis are similar in the incidence of grade B/C pancreatic fistula.In terms of the incidence of postoperative bleeding and delayed gastric emptying in grade B/C,"simple U-shaped end-to-side invagination anastomosis" may have a higher trend of bleeding and delayed gastric emptying.However,compared with "bing’s" duct-to-mucosa anastomosis,"simple U-shaped endto-side invagination anastomosis" has the advantages of simpler operation,shorter time of pancreaticojejunostomy and wider scope of application,so It is worth popularizing in grass-roots hospitals.However,due to the limitations of the study,such as the small sample size and the lack of comparison of long-term outcomes,the reliability of its conclusions still needs to be demonstrated by higher-quality large sample studies in the future.