To evaluate the safety and efficacy of a modified duct-to-mucosa pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD).

Clinical data of 162 patients undergoing PD in the Third Affiliated Hospital of Soochow University from January 2021 to December 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 113 patients were male and 49 female, aged (66±11) years on average. Primary diseases: 66 patients were diagnosed with pancreatic cancer, 47 cases of cholangiocarcinoma, 23 cases of duodenal cancer, 6 cases of ampullar cancer, 1 case of gallbladder cancer, 1 case of adenocarcinoma in the lesser curvature of gastric antrum and 18 cases of benign pancreatic tumors. A modified duct-to-mucosa pancreaticojejunostomy was adopted in the operations including 95 cases undergoing LPD (LPD group) and 67 cases of OPD (OPD group). The overall perioperative conditions and postoperative complications of all patients were observed. The safety and efficacy were compared between two groups. The operation time and intraoperative blood loss between two groups were compared by t test or rank-sum test. The incidence of postoperative complications, such as pancreatic fistula, between two groups was compared by Chi-square test or Fisher's exact test.

All 162 patients successfully completed the surgery. The overall operation time was (317±71) min. The median intraoperative blood loss was 140(100, 200) ml. The length of postoperative hospital stay was 17(12, 25) d.The 30-d mortality rate was 0.6%(1/162). The re-operation rate was 1.9%(3/162). The incidence of postoperative grade B/C pancreatic fistula was 24.7%(40/162). The incidence of gastric emptying disorder was 23.5%(38/162). The incidence of abdominal infection was 13.6%(22/162). The operation time in the LPD group was (338±70) min, significantly longer than (287±63) min in the OPD group (t=4.754, P<0.05). Intraoperative blood loss in the LPD group was 100(100, 150) ml, significantly less than 200(170, 200) mlin the OPD group (Z=-6.075, P<0.05). The length of postoperative hospital stay in the LPD group was 14(12, 21) d, significantly shorter than 18(12, 33) d in the OPD group (Z=-2.040, P<0.05). The incidence of grade B/C pancreatic fistula in the LPD group was 17.7%(17/95), significantly lower than 34.3%(23/67) in the OPD group (χ²=3.659, P<0.05).

The overall incidence of pancreatic fistula is low in patients undergoing modified duct-to-mucosa pancreaticojejunostomy, which is a safe and efficacious procedure. Compared with OPD, LPD probably requires longer operation time, whereas lowers the incidence of postoperative pancreatic fistula. Meantime, LPD has advantages of minimal invasiveness and rapid postoperative recovery, which is recommended for experienced teams.