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Study on the clinical effect of biliary stent implantation before laparoscopic duodenum-preserving pancreatic head resection
LI Wei, LI Sheng-hong, CAO An-ju, ZHAO Li-ping, ZHONG Guo-ping, FAN Cheng-hu, JIANG Hang
Chinese Journal of Practical Surgery ›› 2026, Vol. 46 ›› Issue (3) : 381-387.
PDF(3894 KB)
PDF(3894 KB)
Study on the clinical effect of biliary stent implantation before laparoscopic duodenum-preserving pancreatic head resection
Objective To evaluate the clinical efficacy and safety of preoperative biliary stenting via endoscopic retrograde cholangiopancreatography (ERCP) in laparoscopic duodenum-preserving pancreatic head resection (LDPPHR). Methods The clinical data of 36 patients who underwent LDPPHR at the Third People’s Hospital of Yunnan Province between January 2021 and January 2024 were retrospectively analyzed. According to whether preoperative biliary stenting was performed via ERCP, the patients were divided into the stent group (19 cases) and the non-stent group (17 cases). Perioperative indicators, such as operative time, intraoperative blood loss, and postoperative hospital stay, the incidences of postoperative complications including pancreatic fistula, biliary fistula, hemorrhage, delayed gastric emptying, and biliary stricture with bile duct stones, and the reoperation rate were compared and analyzed between the two groups. Results All 36 patients successfully underwent the surgery without conversion to open surgery. There were no statistically significant differences between the stent group and the non-stent group in operative time [220.00（190.00, 240.00）min vs. 237.50（200.00, 272.25）min], intraoperative blood loss [100.00（100.00, 200.00）mL vs. 100.00（50.00, 275.00）mL，P=0.806], and postoperative hospital stay [21.00（19.00, 25.00）d vs. 24.50（22.00, 27.75）d](all P>0.05). The differences in the incidences of postoperative pancreatic fistula, biliary fistula, hemorrhage, delayed gastric emptying, biliary stricture with stones, and the reoperation rate between the two groups were also not statistically significant (all P>0.05). However, regarding specific complications, the absolute values of the incidence of biliary fistula (5.3% vs. 17.6%) and the reoperation rate (0 vs. 17.6%) in the stent group were lower than those in the non-stent group. In terms of complication management, multiple cases of biliary fistula in the non-stent group required later stenting for cure, and 1 case was forced to undergo surgical bilioenteric anastomosis due to the failure of endoscopic stone extraction, whereas all complications in the stent group were successfully cured by conservative or endoscopic interventions. Conclusion Preoperative prophylactic biliary stenting via ERCP is safe and feasible for LDPPHR, without increasing operative time and blood loss. Pre-stenting helps provide intuitive navigation during surgery to protect the common bile duct. Although it fails to show a statistically significant difference in reducing the incidence of complications limited by the sample size, it simplifies the subsequent management process of complications such as postoperative biliary fistula and biliary stricture to a certain extent, and can serve as an effective adjunct for the perioperative complication management of LDPPHR.
laparoscopic duodenum-preserving pancreatic head resection / endoscopic retrograde cholangiopancreatography / biliary stent / surgical complications
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The risk factors for achieving textbook outcome (TO) after laparoscopic duodenum-preserving total pancreatic head resection (LDPPHR-t) are unknown, and no relevant articles have been reported so far. The aim of this study was to identify the risk factors for achieving TO after LDPPHR-t.
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Although rapid progress has been achieved in laparoscopic pancreaticoduodenectomy (PD) over the last decade, laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) remains a challenging surgery that has been rarely reported due to not only requiring complicated pancreaticojejunostomy (PJ) but also ensuring sufficient blood supplies to duodenum and common bile duct (CBD). We completed LDPPHR for 22 patients safely and efficiently with innovative techniques.Clinical outcomes, including rate of conversion to laparotomy, time of residual pancreatic duct reconstruction, incidence of postoperative complications, and time of hospital stay, were collected for 22 consecutive patients who underwent LDPPHR with innovative techniques as follows: application of indocyanine green (ICG) to visualize and preserve CBD and the vessels supplying the duodenum and CBD, Hong's PJ, and pancreatic duct end-to-end anastomosis (ETEA) for the residual pancreas.All surgeries were performed successfully under laparoscopy except for one case. The duration of ETEA was significantly shorter than PJ (18.2 ± 5.1 min versus 27.5 ± 8.3 min, p < 0.05). There was no significant difference in incidence of postoperative complications between the Hong's PJ and ETEA group. The overall incidence of postoperative pancreatic fistula (POPF) in the Hong's PJ and ETEA group was 23.5% and 20%, respectively, without grade C fistula. All complications were resolved after conservative treatment.By utilizing intraoperative ICG navigation, LDPPHR is a minimally invasive, safe, and efficient approach for chronic pancreatitis with pancreatic head stones by using pancreatic duct ETEA and benign or low-grade malignant tumors of the pancreatic head by using Hong's PJ.
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Potential benefits of local extirpation of benign pancreatic head tumors are tissue conservation of pancreas, stomach, duodenum and common bile duct (CBD) and maintenance of pancreatic functions.Medline/PubMed, Embase and Cochrane Library databases were searched to identify studies applying duodenum-preserving total or partial pancreatic-head resection (DPPHRt/p) and reporting short- and long-term outcomes. Twenty-four studies, including 416 patients who underwent DPPHRt/p, were identified for systematic analysis. The meta-analysis was based on 10 prospective controlled and 4 retrospective controlled cohort studies, comparing 293 DPPHRt/p resections with 372 pancreato-duodenectomies (PD).Of 416 patients, 75.7% underwent total and 24.3% partial head resection, while 47.1% included segmentectomy of duodenum and CBD. The most common pathology was cystic neoplasm (65.8%) and endocrine tumors (13.4%). The frequencies of severe postoperative complications of 8.8%, pancreatic fistula of 19.2%, re-operation of 1.7% and hospital mortality of 0.48%, indicate a low level of early post-operative complications.DPPHRt/p significantly preserved the level of exocrine (IV = -0.67, 95% CI -0.98 to -0.35, p = 0.0001) and endocrine (IV = 18.20, fixed, 95% CI -0.92 to 25.48, p = 0.0001) pancreatic functions compared to PD when the pre- and postoperative functional status in both groups are analyzed. There were no significant differences between DPPHRt/p and PD in frequency of pancreatic fistula, delayed gastric emptying or hospital mortality.DPPHRt/p for benign neoplasms and neuro-endocrine tumors of the pancreatic head is associated with a low level of early-postoperative complications and a better conservation of exocrine and endocrine functions.Copyright © 2015 IAP and EPC. Published by Elsevier B.V. All rights reserved.
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毛易燊, 沈红璋, 陆磊, 等. 内镜下胆管支架在良性胆管狭窄中的应用研究进展[J]. 临床消化病杂志, 2021, 33(6): 453-457. DOI:10.3870/j.issn.1001-4152.2021.11.033.
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