Reverse Needle Continuous Suture of the Pancreatic Duct to Jejunal Mucosal Pancreaticointestinal Anastomosis in Laparoscopic Pancreaticoduodenectomy

Laparoscopic pancreaticoduodenectomy (LPD) is considered the Mount Everest surgery in laparoscopic surgery due to its complex surgical process, high technical requirements, and high incidence of complications. Pancreatic leakage is a common complication of LPD, and severe pancreatic leakage can endanger the patient's life. The occurrence of pancreatic leakage is influenced by multiple factors, and the choice of pancreaticointestinal anastomosis method and the quality of anastomosis are the only controllable factors during surgery. In order to reduce the occurrence of pancreatic leakage, especially severe pancreatic leakage (grade B/C), pancreatic surgeons have continuously improved and innovated the LPD pancreaticointestinal anastomosis method in recent years. Pancreatic duct jejunal mucosal anastomosis is one of the most widely used pancreatic intestinal anastomosis procedures and has been internationally recognized. Due to the unique perspective, operational limitations, and lack of tactile sensation of laparoscopic suturing, it is difficult to complete the anastomosis of the pancreatic duct and jejunal mucosa under laparoscopy for patients with small pancreatic ducts (< 3 mm) and soft and fragile pancreatic tissue. Our team innovatively applied laparoscopic reverse needle continuous suturing of the pancreatic duct to the jejunal mucosa for pancreas-intestine anastomosis. Compared with the traditional laparoscopic pancreatic duct to jejunal mucosa for pancreas intestine anastomosis, it is more in line with the laparoscopic operation perspective, reduces the difficulty of suturing, shortens the anastomosis time, improves the quality of anastomosis, and reduces the occurrence of pancreatic leakage. Moreover, it can reduce the consumption of sutures and minimize the number of knots.