Application of pancreaticojejunostomy without suturing main pancreatic duct in laparoscopic pancreaticoduodenectomy for small main pancreatic duct (≤ 3 mm).

introductionDuct-to-mucosa pancreaticojejunostomy (PJ) is a widely accepted. However, it is difficult to implement during laparoscopic surgery, particularly for a small main pancreatic duct (MPD). We attempted to perform PJ without suturing the main pancreatic duct (WSMPD) and examined its safety and feasibility. MATERIALS AND

methodsWe retrospectively reviewed 126 patients who underwent laparoscopic pancreaticoduodenectomy (LPD) between 2019 and 2024. Among them, 64 patients underwent Blumgart PJ and 62 underwent WSMPD PJ. The patients' demographics and short-term clinical safety were examined.

resultsAfter 1:1 PSM, the WSMPD group had significantly shorter operation and PJ durations and higher biochemical leakage than those in the Blumgart group. However, no significant differences were observed in other postoperative complications between the groups. Furthermore, the operation and PJ durations were shorter in the WSMPD group than in the Blumgart group, regardless of the MPD size (> 3 mm or ≤ 3 mm). In the Blumgart group, patients with MPD ≤ 3 mm had longer PJ duration and hospital stay as well as higher hospital expenses, incidence of B + C grade pancreatic fistula, and incidence of abdominal infection than those with MPD > 3 mm. In the WSMPD group, no significant differences were observed among the patients.

conclusionsWSMPD PJ is a safe, effective, and easy-to-perform method that simplifies LPD procedures. It is particularly suitable for cases involving small MPDs.