Purse-string suture without pancreatic parenchymal stitches in pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy

Aim: Laparoscopic pancreaticoduodenectomy is a controversial procedure because of the technical difficulty of the procedure. Complications are associated with reconstructive surgeries, in particular with pancreaticoenterostomy. In this study, we aimed to develop a method for pancreaticojejunostomy during laparoscopic pancreaticoduodenectomy. Patients and Methods: Five patients received laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. The main pancreatic duct was identified after transection and cannulated with a 5-Fr paediatric feeding tube. Two stay sutures of nonabsorbable 4-0 monofilament were applied in the both side of the pancreas. A hole was opened in the jejunum near the cross section of the pancreatic stump on the antimesenteric side. The surrounding layers of the jejunal hole were purse-string sutured using a nonabsorbable 3-0 suture, and the surgeons ensured that the jejunal muscular layers enveloped the pancreatic stump. Results: We performed a purse-string suture without pancreatic parenchymal stitches in a pancreaticojejunostomy during a laparoscopic pancreaticoduodenectomy in five patients. The patients began to drink water at 5-7 days postoperation. The patients began to eat a soft diet at 13-15 days postoperation. We also administered total parenteral nutrition after surgery. The average blood loss was 850 mL and the average operative time was 532 min. The postoperative hospital stays were 21, 25, 20, 25, and 19 days. Two patients exhibited delayed gastric emptying. No PFe was observed in short-term follow-up up to 6 months postoperation. Conclusion: We successfully performed purse-string suturing without pancreatic parenchymal stitches during the pancreaticojejunostomy. The short-term follow-up exhibited no pancreatic fistulae. This anastomosis technique can be performed safely and easily.