Advance ligation to facilitate pancreaticojejunostomy following pancreaticoduodenectomy by dilating the main pancreatic duct

Masayuki Honda; Masayoshi Hioki; Hiroshi Sadamori; Kazuteru Monden; Go Wakabayashi; Norihisa Takakura

doi:10.21037/gs-20-501

Advance ligation to facilitate pancreaticojejunostomy following pancreaticoduodenectomy by dilating the main pancreatic duct

Gland Surg. 2021 Jan;10(1):59-64. doi: 10.21037/gs-20-501.

Authors

Masayuki Honda^{1

2

3}, Masayoshi Hioki¹, Hiroshi Sadamori¹, Kazuteru Monden¹, Go Wakabayashi³, Norihisa Takakura¹

Affiliations

¹ Department of Surgery, Fukuyama City Hospital, Zaocho, Fukuyama, Hiroshima, Japan.
² Department of Surgery, Sainokuni Higashiomiya Medical Center, Torocho, Kitaku, Saitama, Japan.
³ Department of Surgery, Ageo Central General Hospital, Kashiwaza, Ageo, Saitama, Japan.

Abstract

Background: Duct-to-mucosa pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD) is technically challenging, particularly in cases of soft pancreas with a nondilated main pancreatic duct (MPD). We propose a novel procedure that involves ligating the pancreas in advance to allow for MPD dilation.

Methods: We compared the data of 16 patients who underwent PD followed by PJ with advance ligation (AL) for soft pancreas with a nondilated MPD with that of 17 patients who underwent a conventional procedure (conventional group) without AL at a single institution between January 2015 and April 2017. MPD diameters were assessed using preoperative computed tomography and intraoperative ultrasonography. Pancreatic consistency was judged intraoperatively. The pancreatic parenchyma and MPD were ligated in advance to allow time for MPD dilation. After AL, we divided the pancreatic parenchyma. AL led to MPD dilation and facilitated PJ.

Results: There were significantly fewer complications in the AL group than in the conventional group (P=0.005). There were no cases of pancreatitis or death in either group. The mean procedural time for occluding the MPD was 43 min (range, 21-134 min). The median MPD dilation rate after AL was 1.6 (0.9-3.8).

Conclusions: AL is a simple, safe, and useful procedure for facilitating PJ.

Keywords: Pancreas; ligation; pancreatic duct; pancreaticoduodenectomy (PD); pancreaticojejunostomy (PJ).