Application of modified Kakita pancreaticojejunostomy during pancreaticoduodenectomy
Objective To explore the feasibility of modified Kakita pancreaticojejunostomy(PJ)during pancreaticoduodenectomy(PD).Methods Between May 2018 and June 2022,153 patients undergoing open PJ were selected as group A while 110 patients undergoing mini-invasive PJ as group B.In group A,the procedures included open pancreaticoduodenectomy(OPD,n=135),mini-invasive PD with a conversion into laparotomy(n=13)and mini-invasive PD with a small retrieval incision reconstruction(n=5).In group B,laparoscopic pancreaticoduodenectomy(LPD,n=87)and robotic pancreaticoduodenectomy(RPD,n=23).The perioperative clinical data of two groups were retrospectively reviewed.Results A total of 263 cases of PD were successfully performed.In group A,median time of PJ was 9(7-15)min and median volume of blood loss 200(50-1 000)mL.There were postoperative complication(Clavien-Dindo≥3)(n=18,11.8%),grade B/C postoperative pancreatic fistula(POPF)(n=14,9.2%)and biliary fistula(n=8,5.2%).There were grade B/C intra-abdominal hemorrhage(n=13,8.5%)and gastrointestinal hemorrhage(n=1,0.7%).Fourteen patients(9.2%)were diagnosed as intra-abdominal infection.30-day reoperation occurred in 8 patients(5.2%)and 2 patients(1.3%)died because of grade C POPF within 90 days of surgery.In group B,median time of PJ was 17(12-25)min and median volume of blood loss 60(10-250)mL.Among postoperative complication(Clavien-Dindo≥3)(n=7,6.4%),there were grade B POPF(n=5,4.6%),biliary fistula(n=5,4.6%),grade B/C intra-abdominal hemorrhage(n=3,2.7%)and gastrointestinal hemorrhage(n=1,0.9%).Nine patients(8.2%)were diagnosed as intra-abdominal infection.30-day reoperation occurred(n=3,2.7%)and 1 patient(0.9%)died within 90 days of surgery.Conclusion With a short learning curve,modified Kakita PJ may be performed under OPD or mini-invasive PD.
万方数据
维普
