Introduction : Laparoscopic pancreatoduodenectomy (LPD) is a challenging abdominal operation requiring complex dissection and difficult reconstruction. Especially, pancreaticojejunostomy (PJ) reconstruction is considered the ‘‘Achilles heel’’ of LPD because pancreatic fluid leakage from the procedure is potentially significant morbidity. In the present report, we describe our experience with our inverted mattress (IM) method for LPD,

Methods : Between May 2016 and December 2018, a total of 143 patients with periampullary disease underwent PD at Kyungpook national university chilgok hospital. 43 patients underwent and Open PD was performed on 100 patients. The pancreatic stump was reconstructed using an our IM-PJ technique. Data on the demographic characteristics, operative outcomes and postoperative results of the cases were retrospectively collected and analyzed.

Results : Forty three patients received LPD and 7 patient was converted to open method. The mean age was 63.0 ?12.0 years and gender ratio was 1:1. Mean ASA score and BMI were 1.8 ?0.4 and 23.1 ?3.4 respectively. The mean operation timewas 430 ?73.2 min. Average blood loss was 107.8?94ml. Postoperative pancreatic fistula (POPF) of Grade B occurred in 5.6% and Grade C was not occurred. Also, delayed gastric emptying (DGE) occurred in 15.8%. The mean length of hospital stay was 12.4 ?2.7 days and no postoperative mortality occurred.

Conclusions : The results of the present study suggest the a IM-PJ method is a safe for LPD that is associated with a low risk of POPF. However, these results should be verified by performing randomized control trials.
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