Application Value of Pancreatic Duct-to-Jejunum Stent-Bridging Internal Drainage in Robotic Central Pancreatectomy

ZHANG Enli, WU Junjie, CHEN Mingyue, MA Ben, WU Hanxin, XU Yinzhe, CUI Haozhe, ZHAO Zhiming

Abstract


Objective 

 To conduct preliminary evaluation of the reliability and safety of pancreatic duct-to-jejunum stent-bridging internal drainage as a supplementary approach to pancreaticojejunostomy in central pancreatectomy.

Methods 

 The clinical data of 28 patients who underwent robotic central pancreatectomy performed by our team between January 2021 and November 2024 were retrospectively collected, and and follow-up of postoperative endocrine and exocrine functions was performed. Based on the methods of digestive tract reconstruction adopted, the patients were divided into a conventional pancreaticojejunostomy group and a pancreatic duct-to-jejunum stent-bridging internal drainage group (PancreaticoJejunal-Stent bridge group). The operative time, digestive tract reconstruction time, and short-term complications were compared between the two groups.

Results 

 Among patients undergoing robotic central pancreatectomy, the digestive tract reconstruction time was shorter (t = 5.168, P < 0.001) in the PancreaticoJejunal-Stent bridge group ([31.1 ± 6.3] min) than that in the conventional pancreaticojejunostomy group ([49.7 ± 8.9] min) (t = 5.168, P < 0.001). The total operative time was (172.7 ± 64.6) min in the PancreaticoJejunal-Stent bridge group and (200.1 ± 52.7) min in the conventional pancreaticojejunostomy group, showing no statistically significant difference (t = 1.215, P = 0.235). In the PancreaticoJejunal-Stent bridge group, one patient developed a postoperative biochemical fistula, and 14 patients developed grade B pancreatic fistulas. Among the 14 patients with grade B pancreatic fistulas, 1 case was complicated by fistula-related intra-abdominal infection, and 13 cases had drainage tube retention time of more than 21 days. In the conventional pancreaticojejunostomy group, 2 patients developed postoperative biochemical fistulas, and 11 patients developed grade B pancreatic fistulas. Among the 11 patients with grade B pancreatic fistulas, 1 case was complicated by fistula-related intra-abdominal infection, and 1 case was complicated by fistula-related intra-abdominal bleeding and infection. No postoperative gastroparesis, pancreatitis, or grade C pancreatic fistulas occurred in either group. There were no statistically significant differences between the two groups in overall postoperative complication rate (P = 0.522), postoperative pancreatic fistula rate (P = 0.583), intra-abdominal infection rate (P = 0.583), or bleeding rate (P = 0.464).

Conclusion 

 Pancreatic duct-to-jejunum stent-bridging internal drainage optimizes the anastomosis between the distal end of the pancreas and the jejunum during central pancreatectomy, shortens digestive tract reconstruction time, and reduces surgical complexity without increasing the risk of short-term severe postoperative complications. This approach is safe and feasible.

 

Keywords: Da Vinci robotic surgical system, Central pancreatectomy, Pancreaticojejunostomy

 

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