Ann Hepatobiliary Pancreat Surg.  2023 May;27(2):211-216. 10.14701/ahbps.22-098.

External pancreatic ductal stenting in minimally invasive pancreatoduodenectomy: How to do it?

• Gurram RP
• L HS
• Gnanasekaran S
• Choudhury SR
• Pottakkat B
• Raja K

• KMID: 2542586
• DOI: http://doi.org/10.14701/ahbps.22-098

Abstract

It has been shown that external pancreatic ductal stenting (EPDS) can reduce the incidence of clinically relevant postoperative pancreatic fistula. Although studies have described EPDS in open pancreaticoduodenectomy (PD), EPDS in minimally invasive PD has not been reported yet. Thus, the objective of this study was to describe the technique of EPDS in minimally invasive PD. The procedure was performed either laparoscopically or using a robot. Once PD was completed, key steps included triple enterotomy, threading of silk-suture through all enterotomies and exteriorization, completing posterior layer of pancreaticojejunostomy (PJ), railroading stent through preplaced silk-suture, intubation of stent into the pancreatic duct, completion of PJ, followed by hepaticojejunostomy and parietalization of jejunum at the stent exit site. EPDS in PD through a minimally invasive approach can be performed safely in selected cases with either a small-sized pancreatic duct or a soft pancreas.

Keyword

Pancreatoduodenctomy; Pancreatic duct; Stenting; Minimal invasive; Pancreatic fistula

Figure

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  Fig. 1 Port positions. (A) Laparoscopic pancreaticoduodenectomy, (B) Robot-assisted pancreaticoduodenectomy. R1–4, robotic port 1 to 4; A1, 2, assistant port 1, 2.

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  Fig. 2 (A) Triple enterotomy. (B) Threading of suture through hepaticojejunostomy (HJ) and pancreatojejunostomy, (C) Threading of suture through parietalization site and HJ site.

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  Fig. 3 (A) Completion of posterior layer of pancreaticojejunostomy. (B) Completion of posterior duct to mucosa suture layer. (C) Final appearance after external pancreatic ductal stenting.

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  Fig. 4 Lateral view of a patient with external pancreatic ductal stent in situ, showing pancreatic juice within the tubing and bag.

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