Binding pancreaticogastrostomy in laparoscopic central pancreatectomy: a novel technique in laparoscopic pancreatic surgery

Background Even though more and more cases of laparoscopic central pancreatectomy (LCP) are reported (Machado et al. in Surg Laparosc Endosc Percutan Tech 23(6):486–490, 2013 ; Hong et al. in World J Surg Oncol 10:223, 2012 ; Gonzalez et al. in JOP 14(3):273–276, 2013 , Zhang et al. in J Laparoendosc Adv Surg Tech A 23(11):912–918, 2013 ; Sucandy et al. in N Am J Med Sci 2(9):438–441, 2010 ; Sa Cunha et al. in Surgery 142(3):405–409, 2007 ), the management for pancreatic stumps remains the most technically challenging part which is the same as in pancreatoduodenectomy (PD), making it the bottleneck for laparoscopic pancreatic surgery. In open surgery, various pancreatic reconstruction techniques designed for either pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG) have been attempted to reduce the postoperative pancreatic fistula (POPF), including the binding anastomosis, invented by our team, i.e., binding PG (BPG) and binding PJ, which have been proved to be effective to reduce the POPF (Hong et al. 2012 ; Peng et al. in Ann Surg 245(5):692–698, 2007 ; Peng et al. in Updates Surg 63(2):69–74, 2011 ). However, despite of this, few reports are seen addressing such technique for laparoscopic surgery even though laparoscopic pancreatic surgery is more performed. After a previous successful laparoscopic BPG in a case of laparoscopic CP (LCP; Hong et al. 2012 ) and more than 50 cases of open PD and CP (Peng et al. 2011 ), we further performed laparoscopic BPG in 10 consecutive cases of LCP with satisfactory outcomes. Objective To explore the feasibility and efficacy of LCP with BPG. Methods Between October 2011 and July 2014, LCP with laparoscopic BPG was performed in ten consecutive patients with lesions of benign or low malignancy at the pancreatic neck. Operative and pathological data, complications, hospital stay and details on the surgical techniques were introduced. Results The operations were successfully performed in all the ten cases, with no conversions. The tumor size ranged from 2.0–3.0 to 2.5–3.0 cm, average (2.50 ± 0.35) to (2.66 ± 0.35) cm, and the diameter of pancreatic duct was (1.6–2.1) mm, average (1.71 ± 0.17) mm. Operation time was 170–250 (198.50 ± 25.82) min, and blood loss was 20–300 (125 ± 107.31) mL. Three cases had grade A pancreatic fistula (PF), and one case had delayed gastric emptying, which were all managed with conservative treatment. Upper GI bleeding occurred in one case which was cured with second operation, time fo