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End-to-end invaginated pancreaticojejunostomy during minimally invasive pancreatoduodenectomy: technical description
Manuel Barberio1,2, Antonio Milizia3,4, Margherita Pizzicannella3,5
1Department of Surgery, Ospedale Card. G. Panico, Via Pio X 4, 73039, Tricase, Italy. manuel.barberio@ircad.fr.
Background:
Remarkable progress has been made in pancreatic surgery over the last decades with the introduction of minimally invasive techniques. Minimally invasive pancreatoduodenectomy (MIPD) remains one of the most challenging operations in abdominal surgery and it is performed in a few centers worldwide. The treatment of the pancreatic stump is a crucial step of this operation; however, the best strategy to perform pancreatic anastomosis is still debated. In this article, we describe the technical details of our original technique of modified minimally invasive end-to-end invaginated pancreaticojejunostomy (EIPJ) using video footage.
Methods:
In the current study, we retrospectively analyzed a pilot series of 67 consecutive cases of minimally invasive (7 robotic/60 fully laparoscopic) MIPD operated on at the General Surgery Department of the Panico Hospital, Tricase (Italy) between March 2017 and October 2022.The reconstruction phase involved an EIPJ, tailored using an intra-ductal anastomotic plastic stent. The aim of this study was to describe the technique and evaluate the short-term outcomes of patients undergoing MIPD with EIPJ.
Results:
The mean operative time to perform the EIPJ was 21.57 ± 3.32 min. Seven patients (10.5%) developed biochemical leaks and 13 (19.4%) developed clinically relevant pancreatic fistulas (grade B or C according to the definition of the International Study Group on Pancreatic Surgery).
Conclusion:
The early results confirm that this anastomosis is safe, easy to perform, and effective in the hands of hepatobiliopancreatic (HBP) surgeons with experience in minimally invasive surgery.
Insights
This study introduces a modified minimally invasive end-to-end invaginated pancreaticojejunostomy (EIPJ) for pancreatic surgery. The technique is safe, easy, and effective for experienced surgeons, with acceptable short-term outcomes in pancreatic fistula rates.
Area of Science:
- Surgical Innovation
- Hepatobiliary and Pancreatic Surgery
- Minimally Invasive Surgery
Background:
- Minimally invasive pancreatoduodenectomy (MIPD) is a complex abdominal surgery with ongoing debate on optimal pancreatic stump management.
- Pancreatic anastomosis techniques are critical for successful outcomes in MIPD.
Purpose of the Study:
- To describe a novel modified minimally invasive end-to-end invaginated pancreaticojejunostomy (EIPJ) technique.
- To evaluate the short-term outcomes of MIPD using the EIPJ reconstruction method.
Main Methods:
- Retrospective analysis of 67 consecutive minimally invasive MIPD cases (laparoscopic and robotic).
- Detailed description of the modified EIPJ technique using an intra-ductal anastomotic plastic stent.
- Evaluation of operative time, biochemical leaks, and clinically relevant pancreatic fistulas.
Main Results:
- The mean operative time for EIPJ was 21.57 ± 3.32 minutes.
- Biochemical leaks occurred in 10.5% of patients.
- Clinically relevant pancreatic fistulas (Grade B or C) were observed in 19.4% of patients.
Conclusions:
- The modified EIPJ is a safe and easy-to-perform anastomosis for MIPD.
- The technique is effective in experienced hepatobiliopancreatic (HBP) surgeons performing minimally invasive surgery.
- Early results suggest favorable outcomes for MIPD with EIPJ.
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