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Updated: Apr 25, 2026
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Does minimally-invasive pancreaticoduodenectomy have advantages over its open method? A meta-analysis of
Han Qin1, Jianguo Qiu2, Yiyang Zhao3
1Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
Background:
While more and more open procedures now routinely performed using laparoscopy, minimally invasive pancreaticoduodenectomy (MIPD) remains one of the most challenging abdominal procedures. Therefore, we carried out this meta-analysis to evaluate whether MIPD is safe, feasible and worthwhile.
Methods:
PubMed, EMBASE, and Cochrane Library were searched to identify studies published between January 1994 and November 2013 comparing MIPD with open pancreaticoduodenectomy (OPD). Intraoperative outcomes, oncologic safety, postoperative complications, and postoperative recovery were evaluated.
Results:
11 retrospective studies representing 869 patients (327 MIPDs, 542 OPDs) were included. MIPD was associated with a reduction in estimated blood loss (MD -361.93 ml, 95% CI -519.22 to -204.63 ml, p<0.001, I(2) = 94%), wound infection (OR 0.41, 95% CI 0.22 to 0.78, p = 0.007, I(2) = 0%), and hospital stay (MD -2.64 d, 95% CI -4.23 to -1.05 d, p = 0.001, I(2) = 78%). However, it brings longer operative time (MD 105 min, 95% CI 49.73 to 160.26 min, p<0.001, I(2) = 93%). There were no significant differences between the two procedures in likelihood of overall complications (p = 0.05), pancreatic fistula (PF) (p = 0.86), delayed gastric empting (DGE) (p = 0.96), positive surgical margins (p = 0.07), retrieval of lymph nodes (p = 0.48), reoperation (p = 0.16) and mortality (p = 0.64).
Conclusions:
Our results suggest that MIPD is currently safe, feasible and worthwhile. But considering the selection bias, complexity of MIPD and lack of long-term oncologic outcomes, we suggest it be performed in a high-volume pancreatic surgery center in selected patients.
Insights
Minimally invasive pancreaticoduodenectomy (MIPD) is a safe and feasible surgical option, showing reduced blood loss and shorter hospital stays compared to open procedures. However, it requires longer operative times and should be performed in specialized centers for selected patients.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Minimally invasive pancreaticoduodenectomy (MIPD) is technically demanding, despite the trend towards laparoscopic approaches for abdominal surgeries.
- Evaluating the safety, feasibility, and benefits of MIPD compared to open pancreaticoduodenectomy (OPD) is crucial.
Purpose of the Study:
- To conduct a meta-analysis comparing minimally invasive pancreaticoduodenectomy (MIPD) with open pancreaticoduodenectomy (OPD).
- To assess the safety, feasibility, and oncologic outcomes of MIPD.
Main Methods:
- A systematic literature search was performed on PubMed, EMBASE, and Cochrane Library for studies comparing MIPD and OPD.
- Data from 11 retrospective studies (869 patients) were analyzed, focusing on intraoperative outcomes, oncologic safety, postoperative complications, and recovery.
Main Results:
- MIPD demonstrated significantly reduced estimated blood loss, lower rates of wound infection, and shorter hospital stays compared to OPD.
- Operative time was longer for MIPD, but there were no significant differences in overall complications, pancreatic fistula, delayed gastric emptying, surgical margins, lymph node retrieval, reoperation, or mortality.
- Oncologic safety, including positive surgical margins and lymph node retrieval, was comparable between MIPD and OPD.
Conclusions:
- Minimally invasive pancreaticoduodenectomy (MIPD) is a safe, feasible, and beneficial approach for selected patients.
- Given the complexity and potential selection bias, MIPD should be performed in high-volume pancreatic surgery centers.
- Further research on long-term oncologic outcomes is warranted.
