Dataset Information

Application of purse string suture pancreaticojejunostomy for undilated pancreatic duct in total laparoscopic pancreaticoduodenectomy.

ABSTRACT:

Background

To investigate the feasibility of purse string suture pancreaticojejunostomy in complete laparoscopic pancreaticoduodenectomy for patients with an undilated pancreatic duct.

Methods

We retrospectively reviewed a database of 113 patients with undilated pancreatic ducts who had undergone laparoscopic pancreaticoduodenectomy (LPD) with purse string suture pancreaticojejunostomy to analyze the perioperative outcomes.

Results

One hundred thirteen patients underwent successful LPD. The surgery time was 353 ± 41 min, the time required for pancreaticojejunostomy was 27 ± 5 min, and the hospital stay after surgery was 16 ± 8 days. Fifteen patients suffered postoperative complications, including twelve patients with pancreatic fistula, one with bile leakage, one with gastroparesis (complicated with abdominal infection), and one with abdominal bleeding. No perioperative death occurred.

Conclusions

Purse string suture pancreaticojejunostomy is safe and feasible for patients with an undilated pancreatic duct.

SUBMITTER: Zhou H

PROVIDER: S-EPMC9118586 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Publications

Application of purse string suture pancreaticojejunostomy for undilated pancreatic duct in total laparoscopic pancreaticoduodenectomy.

Zhou Haihua H Yu Shian S Wu Xiaokang X Li Xuemin X

BMC surgery 20220519 1

<h4>Background</h4>To investigate the feasibility of purse string suture pancreaticojejunostomy in complete laparoscopic pancreaticoduodenectomy for patients with an undilated pancreatic duct.<h4>Methods</h4>We retrospectively reviewed a database of 113 patients with undilated pancreatic ducts who had undergone laparoscopic pancreaticoduodenectomy (LPD) with purse string suture pancreaticojejunostomy to analyze the perioperative outcomes.<h4>Results</h4>One hundred thirteen patients underwent su ...[more]

PMID: 35590306

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Project description:BackgroundPostoperative pancreatic fistula (POPF) is often associated with significant morbidity and mortality after the Whipple operation. Patient-related factors associated with POPF include soft pancreatic texture and a small main pancreatic duct (MPD). The traditional duct-to-mucosa anastomosis was modified to be easily performed. The aim of the study was to evaluate the simplified pancreaticojejunostomy (PJ) method in the prevention of POPF after minimally invasive pancreaticoduodenectomy (PD).MethodsNinety-eight patients who underwent laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD) with a simplified PJ procedure containing only two duct-to-mucosa sutures and four penetrating-sutures to anastomose the pancreatic parenchyma and jejunal seromuscular layer in our center were retrospectively studied. Demographics and clinical short-term safety were assessed.ResultsAll LPD and RPD procedures were successfully performed. The median time of PJ was 17 min, and the median blood loss was 60 mL, with only one patient requiring transfusion. Four patients (4.1%) suffered from clinically relevant POPF (CR-POPF), including four grade B cases and no grade C cases. For patients with an MPD diameter of 3 mm or less, POPF was noted in two (4%) of the fifty patients, with all cases being grade B. Of the patients with a soft pancreas, only two (4.5%) patients suffered from grade B POPF. One patient (1.0%) experienced a 90-day mortality. Neither the main pancreatic diameter nor pancreatic texture had an impact on postoperative outcomes.ConclusionsOur technique is a simple, safe and efficient alternative to prevent POPF after LPD and RPD. This method is suitable for almost all pancreatic conditions, including cases with a small main pancreatic duct and soft pancreas, and has the potential to become the preferred procedure in low-volume pancreatic surgery centers. Our modified duct-to-mucosa PJ, which contains only two duct-to-mucosa sutures and four penetrating-sutures to anastomose the pancreatic parenchyma and jejunal seromuscular layer, is ideal for small MPD and soft pancreas when performing minimally invasive PD and has a low rate of POPF. PJ pancreaticojejunostomy, MPD main pancreatic diameter, PD pancreaticoduodenectomy, POPF postoperative pancreatic fistula.

Project description:Background Pancreatic leakage remains one of the most serious complications after laparoscopic pancreaticoduodenectomy (LPD). At present, most medical centers use local materials for the common pancreatic duct catheters required for pancreaticoenterostomy. However, there is a lack of a measurable and variable-diameter pancreatic duct catheter. Recently, a measurable variable-diameter pancreatic duct catheter was developed to remedy the limitation of the common pancreatic duct catheters. This study sought to evaluate its preventive effect on pancreatic leakage in LPD. Methods A total of 202 patients who underwent LPD using the Hong’s single-stitch method from January 2021 to April 2022 were included in the study. Patients were divided into the 2 groups: the variable-diameter group (n=111) and the normal group (n=91) according to the application of different pancreatic duct catheters. Patient characteristics and perioperative data, including operation time, pancreatic fistula rate, postoperative bleeding rate and postoperative length of stay in the two groups were collected and analyzed. The Chi-square test was used to compare the differences between the groups in relation to the categorical variables. Results Among the 202 patients, there were 123 males and 79 females, with an average age of 58.79±7.89 years (range, 15–79 years), and an average body mass index (BMI) of 23.55±4.25 kg/m2. There were no statistically significant differences between the variable-diameter group and the normal group in terms of age, sex, BMI, operation time, intraoperative blood loss, preoperative bilirubin, and pancreatic texture (P>0.05). The pancreatic fistula rate (2.70% vs. 9.89%) and postoperative median length of stay (15 vs. 16 days) of the variable-diameter group was significantly lower than that of the normal group. Conclusions The measurable variable-diameter pancreatic duct catheter could decrease the pancreatic fistula rate and postoperative median length of stay in the application of laparoscopic duodenectomy.

Project description:Abstract Background Purse-string suture in transanal total mesorectal excision is a key procedural step. The aims of this study were to develop an automatic skill assessment system for purse-string suture in transanal total mesorectal excision using deep learning and to evaluate the reliability of the score output from the proposed system. Methods Purse-string suturing extracted from consecutive transanal total mesorectal excision videos was manually scored using a performance rubric scale and computed into a deep learning model as training data. Deep learning-based image regression analysis was performed, and the purse-string suture skill scores predicted by the trained deep learning model (artificial intelligence score) were output as continuous variables. The outcomes of interest were the correlation, assessed using Spearman’s rank correlation coefficient, between the artificial intelligence score and the manual score, purse-string suture time, and surgeon’s experience. Results Forty-five videos obtained from five surgeons were evaluated. The mean(s.d.) total manual score was 9.2(2.7) points, the mean(s.d.) total artificial intelligence score was 10.2(3.9) points, and the mean(s.d.) absolute error between the artificial intelligence and manual scores was 0.42(0.39). Further, the artificial intelligence score significantly correlated with the purse-string suture time (correlation coefficient = −0.728) and surgeon’s experience (P< 0.001). Conclusion An automatic purse-string suture skill assessment system using deep learning-based video analysis was shown to be feasible, and the results indicated that the artificial intelligence score was reliable. This application could be expanded to other endoscopic surgeries and procedures. The aims of this study were to develop an automatic skill assessment system for purse-string suture in transanal total mesorectal excision (TaTME) using artificial intelligence (AI) and to evaluate the reliability of the score output. The score output by AI exhibited statistically significant correlation with the manual score, purse-string suture time, and surgeon’s experience. To the best of our knowledge, this is the first report on automatic skill assessment for purse-string suture in TaTME.

Dataset Information

Application of purse string suture pancreaticojejunostomy for undilated pancreatic duct in total laparoscopic pancreaticoduodenectomy.

Background

Methods

Results

Conclusions

Publications

Application of purse string suture pancreaticojejunostomy for undilated pancreatic duct in total laparoscopic pancreaticoduodenectomy.

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