title: Laparoscopic pancreaticojejunostomy using a barbed suture: a novel technique.
abstract: OBJECTIVE
  The adoption of laparoscopy for the Whipple procedure remains limited in part by its technical difficulty. We sought to develop a superior, simpler pancreaticojejunostomy technique.
  
  
  METHODS
  We applied a running barbed suture (V-Loc™; Covidien, Mansfield, MA) to perform the pancreaticojejunostomy over a stent placed in the pancreatic duct and a small enterotomy in the jejunum. This technique was attempted in the last 19 of 37 patients presenting to two surgeons (M.A.M. and B.H.E.) for a laparoscopic Whipple procedure. Data were collected on operative time, pancreatic leak events, and related complications.
  
  
  RESULTS
  We successfully applied the modified technique in all 19 patients. Pancreatic leak occurred in 5% of patients with the modified technique (Grade A=0; Grade B=1; Grade C=0) and 11% with the standard technique (Grade A=1; Grade B=1; Grade C=0). All leaks were managed with external drainage. There were no leak-related complications. Mean operative time was shorter for the modified technique (mean, 367 minutes; range, 260-576 minutes) than the standard technique (mean, 440 minutes; range, 300-665 minutes).
  
  
  CONCLUSIONS
  The use of a running barbed suture for laparoscopic pancreaticojejunostomy is a safe and efficient technique. Our operative times were decreased with this technique, and our outcomes were similar to other laparoscopic Whipple series.
authors.affiliation: 1 Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: Michol A
authors.initials: MA
authors.lastname: Cooper
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000601:surgery; D010193:Pancreaticojejunostomy / Q000379:methods*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome