Application of laparoscopic pancreaticoduodenectomy guided by membrane anatomy: a report of 17 cases

Department of Hepatopancreatobiliary Surgery, Liuzhou People′s Hospital Affiliated to Guangxi Medical University, Liuzhou 545006, Guangxi, China

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    Background and Aims Laparoscopic pancreaticoduodenectomy (LPD) has developed rapidly in recent years. However, the complexity of the essential techniques such as dissection, separation, and anastomosis involved in this operation limits its widespread application. Based on the successful application of the membrane anatomy concept in the field of gastrointestinal surgery, the author's team preliminarily explored the clinical application value of the membrane anatomy concept in LPD.Methods The clinicopathologic data of 17 patients with pancreatic head and ampullary tumors who underwent LPD based on the concept of membrane anatomy from March to September 2021 in Liuzhou People's Hospital Affiliated with Guangxi Medical University were retrospectively collected. The perioperative conditions and short-term outcomes of the patients were analyzed.Results Among the 17 patients, 10 cases were males and 7 cases were females, with a median age of 58 (42-76) years; the preoperative body mass index was (22.95±2.73) kg/m2, CA19-9 value was (147.59±23.04) U/mL, and total bilirubin level was (124.50±26.26) μmol/L. LPD was successfully completed in all 17 patients. The average total operative time was (324±58) min, the median operative time before digestive tract reconstruction was 160 (120-320) min, the average bleeding volume was (353±192) mL, and the size of the lesion was (2.75±0.21) cm. There were 4 cases of duodenal papillary carcinoma, 7 cases of pancreatic cancer, 5 cases of ampullary cancer of the pancreaticobiliary subtype, and 1 case of duodenal neuroendocrine tumor; the number of harvested lymph nodes was 12 (5-17), and the number of positive lymph nodes was 7 (0-11). After the operation, biochemical leakage occurred in 2 cases, and no grade B or C pancreatic fistula occurred; delayed gastric emptying occurred in one case who resumed a solid diet within postoperative 10 d after replacing the gastric tube and symptomatic treatment; no abdominal infection and bleeding occurred; The postoperative hospitalization time of 17 patients was 11(9-21) d; No death occurred within 30 d after operation. All the 17 patients were followed up for 3.0-9.0 months with a median follow-up time of 5.7 months. No death and recurrence occurred.Conclusion The LPD based on the concept of membrane anatomy has less bleeding during the operation, and is helpful for keeping the clear vision of the surgical field, following the "tumor free principle" of surgery, reducing the occurrence of surgical complications, and shortening the length of hospitalization of patients, which makes the operation safe and feasible. Its short-term effect is satisfactory, and the long-term effect needs to be further observed. To a certain extent, it is worth to be widely applied and popularized.

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TAN Shengqiang, WEI Min, LIU Zhen, WU Yongrong, JIANG Zhijun, LU Yi, CAI Jingming, CHEN Limin, ZHOU Zheng. Application of laparoscopic pancreaticoduodenectomy guided by membrane anatomy: a report of 17 cases[J]. Chin J Gen Surg,2022,31(9):1145-1153.
DOI:10.7659/j. issn.1005-6947.2022.09.003

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  • Received:February 09,2022
  • Revised:June 08,2022
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  • Online: September 30,2022
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