Abstract: Objective:To investigate the application value of pancreaticojejunostomy with doublelayer continuous suture in total laparoscopic pancreaticoduodenectomy (TLPD).
Methods:The retrospective crosssectional study was conducted. The clinicopathological data of 21 patients who underwent TLPD with pancreaticojejunostomy using doublelayer continuous suture in the Second Hospital of Jilin University between January and December 2017 were collected. The anastomosis used Child method, and pancreaticojejunostomy, choledochojejunostomy and gastroenteric anastomosis in turn were done. Observation indicators: (1) surgical and postoperative recovery; (2) postoperative pathological examination; (3) followup and survival situations. Followup using outpatient examination and telephone interview was performed to detect postoperative survival and tumor recurrence or metastasis up to February 2018. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (P25，P75).
Results:(1) Surgical and postoperative recovery: 21 patients underwent successful TLPD with pancreaticojejunostomy with doublelayer continuous suture. The operation time, time of pancreaticojejunostomy and volume of intraoperative blood loss were respectively (352±25)minutes, (46±8)minutes and (168±34)mL. There was no intraoperative blood transfusion. The time of postoperative abdominal drainagetube removal was (10.1±4.4)days. Of 21 patients, 12 were complicated with biochemical fistula, and 3 with grading B of pancreatic fistula (pancreatic duct in type Ⅱ), and they were improved by inhibiting pancreatic secretion and drainage patency. There was no occurrence of biliary fistula, chylous fistula, postoperative bleeding, abdominal infection and delayed gastric emptying. The duration of postoperative hospital stay of 21 patients was (11.3±2.0)days. (2) Postoperative pathological examination: surgical margins of 21 patients were negative. The pathological type: 8, 6, 4, 2 and 1 patients were diagnosed as distal bile duct cancer, ampulla cancer, duodenal papilla and duodenal cancer, pancreatic head cancer and neuroendocrine cancer of ampulla, respectively. (3) Followup and survival situations: 21 patients were followed up for 3-12 months, with a median time of 7 months. During the followup, all the patients survived, and there was no tumor recurrence and metastasis.
Conclusion:Pancreaticojejunostomy with doublelayer continuous suture is safe and feasible for TLPD, with advantages of exact anastomosis effect and good application value.