title: Imbedding pancreaticojejunostomy used in pure laparoscopic pancreaticoduodenectomy for nondilated pancreatic duct.
abstract: LPD has been cautiously regarded as feasible and safe for resection and reconstruction. However, anastomosis of the remnant pancreas is still thought to be a critical obstacle to the dissemination of LPD in general practice. This study presents a new technique of pancreaticojejunostomy for nondilated pancreatic duct and evaluates its safety and reliability.
  
  
  
  From July 2014 to June 2015, a total of 52 patients underwent LPD with the new technique. A modified technique of duct-to-mucosa PJ was performed with transpancreatic interlocking mattress sutures, named the imbedding duct-to-mucosa PJ. Then the morbidity and mortality was calculated.
  
  
  
  This technique was applied in 52 patients after LPD all with nondilated pancreatic duct (1-3 mm). The mean operation time was 4.6 h (range, 3.5-8.3 h) and the median time for the anastomosis was 37 min (range, 24-53 min). Operative mortality was zero, and morbidity was 21.2 % (n = 11), including hemorrhage (n = 3, 5.8 %), biliary fistula (n = 1, 1.9 %), pulmonary infection (n = 1, 1.9 %), delayed gastric emptying (n = 2, 3.8 %), abdominal abscess caused by biliary fistula or PF formation (n = 2, 3.8 %), and POPF (n = 2, 3.8 %). Two patients developed a pancreatic fistula (one type A, one type B) classified according to the International Study Group on Pancreatic Fistula.
  
  
  
  The described technique is a simple and safe reconstruction procedure after LPD, especially for patients with nondilated pancreatic duct.
authors.affiliation: Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China.
authors.forename: Min
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Endocrinology, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Simiao
authors.initials: S
authors.lastname: Xu
authors.affiliation: Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China.
authors.forename: Hang
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310016, People's Republic of China.
authors.forename: Shuyou
authors.initials: S
authors.lastname: Peng
authors.affiliation: Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China. zfjch1977@sina.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Zhu
authors.affiliation: Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China. ryqin@tjh.tjmu.edu.cn.
authors.forename: Renyi
authors.initials: R
authors.lastname: Qin
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology; D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D000714:Anastomosis, Surgical / Q000379:methods; D001650:Bile Duct Neoplasms / Q000601:surgery; D001658:Biliary Fistula / Q000453:epidemiology*; D003424:Crohn Disease / Q000601:surgery; D018291:Cystadenoma, Mucinous / Q000601:surgery; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery; D018589:Gastroparesis / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008223:Lymphoma / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010179:Pancreas / Q000601:surgery; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D015203:Reproducibility of Results; D013536:Suture Techniques; D013537:Sutures
keywords: Laparoscopic pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative pancreatic fistula