Laparoscopic pancreaticojejunostomy using a barbed suture: a novel technique

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Laparoscopic Whipple procedure adoption is hindered by technical challenges, particularly pancreaticojejunostomy.
• Developing simpler, safer techniques is crucial for expanding minimally invasive pancreaticoduodenectomy.

Purpose of the Study:

• To introduce and evaluate a novel, simplified running barbed suture technique for laparoscopic pancreaticojejunostomy.
• To assess the safety, efficiency, and outcomes of this modified technique compared to standard methods.

Main Methods:

• A running barbed suture (V-Loc™) was used for pancreaticojejunostomy in 19 patients undergoing laparoscopic Whipple procedure.
• The technique involved placing a stent in the pancreatic duct and a small enterotomy in the jejunum.
• Data collected included operative time, pancreatic leak events, and complications.

Main Results:

• The modified technique was successfully applied in all 19 patients.
• Pancreatic leak rate was 5% with the barbed suture technique versus 11% with the standard technique.
• Mean operative time decreased significantly from 440 minutes (standard) to 367 minutes (modified).
• No leak-related complications occurred; all leaks were managed with external drainage.

Conclusions:

• Running barbed suture facilitates a safe and efficient laparoscopic pancreaticojejunostomy.
• This technique reduces operative time in laparoscopic Whipple procedures.
• Outcomes are comparable to existing laparoscopic Whipple series, suggesting improved feasibility.