Achilles’heel of laparoscopic pancreatectomy: reconstruction of the remnant pancreas

ABSTRACT

Introduction

Laparoscopic pancreatic reconstruction is a challenging procedure and is considered the Achilles’ heel of laparoscopic pancreatectomy. Multiple techniques of laparoscopic pancreatic reconstruction have been reported, but the optimal technique remains unclear.

Areas covered

This paper provides a brief introduction to the developmental status and major related complications of laparoscopic pancreatic reconstruction. We reviewed all published literature on the technology of laparoscopic pancreatic reconstruction within the last 5 years and herein discuss the advantages and disadvantages of different reconstruction methods. We also discuss several details of different reconstruction techniques in terms of their significance to the operation and complications.

Expert opinion

No individual method of laparoscopic pancreatic reconstruction is considered optimal for all conditions. The reconstruction strategy should be based on the surgeon’s proficiency with laparoscopic technology and the patient’s individual risk factors. Personalized methods of pancreatic reconstruction may more effectively reduce morbidity and mortality.

KEYWORDS:

• Laparoscopic technology
• pancreatectomy
• pancreatic fistula
• pancreaticojejunostomy
• pancreaticogastrostomy

Article highlights

• Laparoscopic reconstruction of the remnant pancreas is mainly classified as laparoscopic pancreaticojejunostomy and laparoscopic pancreatogastrostomy. Laparoscopic duct-to-mucosa pancreaticojejunostomy is currently the most popular technique.

• Although no pancreatic reconstruction method is optimal at present, each method has its specific advantages, disadvantages, and adaptability.

• Details of the pancreatic reconstruction technique performed under laparoscopy, such as the management of the jejunal loop, the blood supply of pancreatic stump, use of pancreatic duct stenting, and the suture materials used, may affect the quality of anastomosis.

• Personalized methods of pancreatic reconstruction under laparoscopy may more effectively reduce morbidity and mortality.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This work was supported by the health project of Jilin province department of Finance (2019SCZT009 and 2018GDYYZ001).