He Long, Cui Jing, Zhou Xiaoxiao, Peng Tao, Zhao Chuanbing, Lu Yu, Gao Antong, Yin Tao
Objective This study aims to assess the effectiveness of a modified Chen's pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD). Methods A retrospective analysis was conducted on the clinical data of 121 patients who underwent LPD at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2023 and October 2024. The patients were divided into two groups: traditional surgery group (63 patients) and modified Chen's pancreaticojejunostomy (modified surgery group) (58 patients). Gender, age, body mass index (BMI), operation time, pancreatojejunostomy time, intraoperative blood loss, postoperative hospital stay, and the incidence of postoperative complications like pancreatic fistula, abdominal infection, intra-abdominal bleeding, gastrointestinal dysfunction, and mortality were compared between groups. Additionally, moderate-to-high risk patients for pancreatic fistula were identified using the alternative pancreatic fistula risk score system (a-FRS). The risk of pancreatic fistulas between groups was compared. Quantitative data adhering to a normal distribution were expressed as $\bar{x}±s$ ; otherwise, they were expressed as quartiles [M(Q1,Q3)]. Count data were presented as the number of instances. Results Patients in the modified surgery group showed significantly shorter operation time(311.8±55.0 min vs. 357.5±84.5 min,P=0.001)and pancreatojejunostomy time [15.5 (13.8,18.0) min vs. 26.0 (23.0,29.0) min,P<0.001] compared to the traditional surgery group. The incidence of clinically relevant postoperative pancreatic fistula was also significantly lower in the modified surgery group than in the traditional surgery group [3.4% (2/58) vs. 15.9% (10/63), P=0.022]. There were no significant differences between the two groups in the age, gender, BMI, proportion of patients at moderate-to-high risk for pancreatic fistula, intraoperative blood loss, postoperative hospital stay, rates of abdominal infection, intra-abdominal bleeding, and gastrointestinal dysfunction (P>0.05). There were no perioperative deaths in both groups. Among the 62 patients at a moderate-to-high risk for pancreatic fistula using the a-FRS model (34 in the traditional surgery group and 28 in the modified surgery group), those in the modified surgery group still showed significantly shorter operation and pancreatojejunostomy times (P<0.05) and a lower incidence of postoperative pancreatic fistula (P=0.036). Conclusion The modified Chen's pancreaticojejunostomy simplifies the procedure, decreases the duration of pancreatojejunostomy, and reduces the occurrence of pancreatic fistulas. This technique is effective for patients assessed as having a moderate-to-high risk of developing pancreatic fistulas.