Blumgart method using LAPRA-TY clips facilitates pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy
The modified Blumgart method for pancreaticojejunostomy has been shown to reduce the rate of postoperative pancreatic fistula (POPF) in open surgery. We describe a modified Blumgart method using LAPRA-TY suture clips to facilitate laparoscopic pancreaticojejunostomy.We prepared a double-armed 4-0 no...
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| Veröffentlicht in: | Medicine (Baltimore) 2020-03, Vol.99 (10), p.e19474-e19474 |
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| creator | Nagakawa, Yuichi Takishita, Chie Hijikata, Yosuke Osakabe, Hiroaki Nishino, Hitoe Akashi, Masanori Nakajima, Tetsushi Shirota, Tomoki Sahara, Yatsuka Hosokawa, Yuichi Ishizaki, Tetsuo Katsumata, Kenji Tsuchida, Akihiko |
| description | The modified Blumgart method for pancreaticojejunostomy has been shown to reduce the rate of postoperative pancreatic fistula (POPF) in open surgery. We describe a modified Blumgart method using LAPRA-TY suture clips to facilitate laparoscopic pancreaticojejunostomy.We prepared a double-armed 4-0 nonabsorbable monofilament, which was ligated using the LAPRA-TY clip at the tail end, 12-cm in length. Next, the U-suture was placed through the pancreatic stump and the seromuscular layer of the jejunum. We performed duct-to-mucosa suturing with a 5-0 absorbable monofilament. After completing the duct-to-mucosa suturing, as a final step we placed the sutures through the seromuscular layer of the jejunum on the ventral side and tightly secured the thread with the LAPRA-TY clips. We performed laparoscopic Blumgart pancreaticojejunostomy during pancreaticoduodenectomy in 39 patients. We compared the surgical outcomes of 19 patients who underwent Blumgart pancreaticojejunostomy using the LAPRA-TY clips (LAPRA-TY group) with 20 patients undergoing surgery not using the LAPRA-TY clips (conventional group).The rate of clinically relevant postoperative pancreatic fistula in the LAPRA-TY group was 21.1%, which did not differ significantly from the rate of the conventional group. However, the mean time of pancreaticojejunostomy in the LAPRA-TY group was 56.2 min (range, 39-79 min), which was significantly shorter than that of the conventional group (69.7 min; range, 53-105 min, P |
| doi_str_mv | 10.1097/MD.0000000000019474 |
| format | Article |
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We describe a modified Blumgart method using LAPRA-TY suture clips to facilitate laparoscopic pancreaticojejunostomy.We prepared a double-armed 4-0 nonabsorbable monofilament, which was ligated using the LAPRA-TY clip at the tail end, 12-cm in length. Next, the U-suture was placed through the pancreatic stump and the seromuscular layer of the jejunum. We performed duct-to-mucosa suturing with a 5-0 absorbable monofilament. After completing the duct-to-mucosa suturing, as a final step we placed the sutures through the seromuscular layer of the jejunum on the ventral side and tightly secured the thread with the LAPRA-TY clips. We performed laparoscopic Blumgart pancreaticojejunostomy during pancreaticoduodenectomy in 39 patients. We compared the surgical outcomes of 19 patients who underwent Blumgart pancreaticojejunostomy using the LAPRA-TY clips (LAPRA-TY group) with 20 patients undergoing surgery not using the LAPRA-TY clips (conventional group).The rate of clinically relevant postoperative pancreatic fistula in the LAPRA-TY group was 21.1%, which did not differ significantly from the rate of the conventional group. However, the mean time of pancreaticojejunostomy in the LAPRA-TY group was 56.2 min (range, 39-79 min), which was significantly shorter than that of the conventional group (69.7 min; range, 53-105 min, P < .001).Although the modified Blumgart pancreaticojejunostomy using LAPRA-TY suture clips did not improve the pancreatic fistula rate, it allowed for shorter operative times. Thus, this procedure lends itself to positive surgical and patient outcomes.</description><identifier>ISSN: 0025-7974</identifier><identifier>EISSN: 1536-5964</identifier><identifier>DOI: 10.1097/MD.0000000000019474</identifier><identifier>PMID: 32150110</identifier><language>eng</language><publisher>United States: the Author(s). Published by Wolters Kluwer Health, Inc</publisher><subject>Anastomosis, Surgical - instrumentation ; Female ; Humans ; Laparoscopy - instrumentation ; Male ; Middle Aged ; Pancreatic Fistula - surgery ; Pancreaticoduodenectomy ; Pancreaticojejunostomy - instrumentation ; Postoperative Complications ; Quality Improvement Study ; Surgical Instruments ; Suture Techniques ; Treatment Outcome</subject><ispartof>Medicine (Baltimore), 2020-03, Vol.99 (10), p.e19474-e19474</ispartof><rights>the Author(s). Published by Wolters Kluwer Health, Inc.</rights><rights>Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4506-6990d4495c19cfa3f4090344eee89029ae613a3a36e27b09a91a6aec766286e73</citedby><cites>FETCH-LOGICAL-c4506-6990d4495c19cfa3f4090344eee89029ae613a3a36e27b09a91a6aec766286e73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478424/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478424/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32150110$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nagakawa, Yuichi</creatorcontrib><creatorcontrib>Takishita, Chie</creatorcontrib><creatorcontrib>Hijikata, Yosuke</creatorcontrib><creatorcontrib>Osakabe, Hiroaki</creatorcontrib><creatorcontrib>Nishino, Hitoe</creatorcontrib><creatorcontrib>Akashi, Masanori</creatorcontrib><creatorcontrib>Nakajima, Tetsushi</creatorcontrib><creatorcontrib>Shirota, Tomoki</creatorcontrib><creatorcontrib>Sahara, Yatsuka</creatorcontrib><creatorcontrib>Hosokawa, Yuichi</creatorcontrib><creatorcontrib>Ishizaki, Tetsuo</creatorcontrib><creatorcontrib>Katsumata, Kenji</creatorcontrib><creatorcontrib>Tsuchida, Akihiko</creatorcontrib><title>Blumgart method using LAPRA-TY clips facilitates pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy</title><title>Medicine (Baltimore)</title><addtitle>Medicine (Baltimore)</addtitle><description>The modified Blumgart method for pancreaticojejunostomy has been shown to reduce the rate of postoperative pancreatic fistula (POPF) in open surgery. We describe a modified Blumgart method using LAPRA-TY suture clips to facilitate laparoscopic pancreaticojejunostomy.We prepared a double-armed 4-0 nonabsorbable monofilament, which was ligated using the LAPRA-TY clip at the tail end, 12-cm in length. Next, the U-suture was placed through the pancreatic stump and the seromuscular layer of the jejunum. We performed duct-to-mucosa suturing with a 5-0 absorbable monofilament. After completing the duct-to-mucosa suturing, as a final step we placed the sutures through the seromuscular layer of the jejunum on the ventral side and tightly secured the thread with the LAPRA-TY clips. We performed laparoscopic Blumgart pancreaticojejunostomy during pancreaticoduodenectomy in 39 patients. We compared the surgical outcomes of 19 patients who underwent Blumgart pancreaticojejunostomy using the LAPRA-TY clips (LAPRA-TY group) with 20 patients undergoing surgery not using the LAPRA-TY clips (conventional group).The rate of clinically relevant postoperative pancreatic fistula in the LAPRA-TY group was 21.1%, which did not differ significantly from the rate of the conventional group. However, the mean time of pancreaticojejunostomy in the LAPRA-TY group was 56.2 min (range, 39-79 min), which was significantly shorter than that of the conventional group (69.7 min; range, 53-105 min, P < .001).Although the modified Blumgart pancreaticojejunostomy using LAPRA-TY suture clips did not improve the pancreatic fistula rate, it allowed for shorter operative times. Thus, this procedure lends itself to positive surgical and patient outcomes.</description><subject>Anastomosis, Surgical - instrumentation</subject><subject>Female</subject><subject>Humans</subject><subject>Laparoscopy - instrumentation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pancreatic Fistula - surgery</subject><subject>Pancreaticoduodenectomy</subject><subject>Pancreaticojejunostomy - instrumentation</subject><subject>Postoperative Complications</subject><subject>Quality Improvement Study</subject><subject>Surgical Instruments</subject><subject>Suture Techniques</subject><subject>Treatment Outcome</subject><issn>0025-7974</issn><issn>1536-5964</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1v1DAQhi0EokvhFyChHLmkHX_EXl-Qln5Apa1AqBw4Wa4z2fXixMF2qPrvSdlSCp6DJc8z77zWS8hrCkcUtDq-PD2Cv4dqocQTsqANl3WjpXhKFgCsqZVW4oC8yHk3Q1wx8ZwccEYboBQWJL4PU7-xqVQ9lm1sqyn7YVOtV5-_rOqrb5ULfsxVZ50PvtiCuRrt4BLa4l3c4W4aYi6xv638UAU72hSzi6N3j7F2ii0O6O64l-RZZ0PGV_f3Ifl6fnZ18rFef_pwcbJa1040IGupNbRC6MZR7TrLOwEauBCIuNTAtEVJuZ1LIlPXoK2mVlp0Skq2lKj4IXm31x2n6x5bh0NJNpgx-d6mWxOtN_92Br81m_jTKKGWgolZ4O29QIo_JszF9D47DMEOGKdsGFfN7FQsYUb5HnXz73PC7mENBXMXlbk8Nf9HNU-9eezwYeZPNjMg9sBNDAVT_h6mG0xmizaU7W-9RmlWM2AAHCTU84uU_Bfqs6FB</recordid><startdate>20200301</startdate><enddate>20200301</enddate><creator>Nagakawa, Yuichi</creator><creator>Takishita, Chie</creator><creator>Hijikata, Yosuke</creator><creator>Osakabe, Hiroaki</creator><creator>Nishino, Hitoe</creator><creator>Akashi, Masanori</creator><creator>Nakajima, Tetsushi</creator><creator>Shirota, Tomoki</creator><creator>Sahara, Yatsuka</creator><creator>Hosokawa, Yuichi</creator><creator>Ishizaki, Tetsuo</creator><creator>Katsumata, Kenji</creator><creator>Tsuchida, Akihiko</creator><general>the Author(s). 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We describe a modified Blumgart method using LAPRA-TY suture clips to facilitate laparoscopic pancreaticojejunostomy.We prepared a double-armed 4-0 nonabsorbable monofilament, which was ligated using the LAPRA-TY clip at the tail end, 12-cm in length. Next, the U-suture was placed through the pancreatic stump and the seromuscular layer of the jejunum. We performed duct-to-mucosa suturing with a 5-0 absorbable monofilament. After completing the duct-to-mucosa suturing, as a final step we placed the sutures through the seromuscular layer of the jejunum on the ventral side and tightly secured the thread with the LAPRA-TY clips. We performed laparoscopic Blumgart pancreaticojejunostomy during pancreaticoduodenectomy in 39 patients. We compared the surgical outcomes of 19 patients who underwent Blumgart pancreaticojejunostomy using the LAPRA-TY clips (LAPRA-TY group) with 20 patients undergoing surgery not using the LAPRA-TY clips (conventional group).The rate of clinically relevant postoperative pancreatic fistula in the LAPRA-TY group was 21.1%, which did not differ significantly from the rate of the conventional group. However, the mean time of pancreaticojejunostomy in the LAPRA-TY group was 56.2 min (range, 39-79 min), which was significantly shorter than that of the conventional group (69.7 min; range, 53-105 min, P < .001).Although the modified Blumgart pancreaticojejunostomy using LAPRA-TY suture clips did not improve the pancreatic fistula rate, it allowed for shorter operative times. Thus, this procedure lends itself to positive surgical and patient outcomes.</abstract><cop>United States</cop><pub>the Author(s). Published by Wolters Kluwer Health, Inc</pub><pmid>32150110</pmid><doi>10.1097/MD.0000000000019474</doi><oa>free_for_read</oa></addata></record> |
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| source | Wolters Kluwer Open Health; MEDLINE; DOAJ Directory of Open Access Journals; IngentaConnect Free/Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Anastomosis, Surgical - instrumentation Female Humans Laparoscopy - instrumentation Male Middle Aged Pancreatic Fistula - surgery Pancreaticoduodenectomy Pancreaticojejunostomy - instrumentation Postoperative Complications Quality Improvement Study Surgical Instruments Suture Techniques Treatment Outcome |
| title | Blumgart method using LAPRA-TY clips facilitates pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy |
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