[Application of the "2+3" pancreaticojejunostomy in 110 cases of pancreaticoduodenectomy].

Authors

S L Guo, S H Chen, H Liu, L Wang, J W Xu

Published in

Zhonghua wai ke za zhi [Chinese journal of surgery]. Volume 64. Issue 8. Pages 887-893. Jun 26, 2026. Epub Jun 26, 2026.

Abstract

Objective: To report the outcomes and evaluate the safety of the "2+3"pancreaticojejunostomy in pancreaticoduodenectomy. Methods: This retrospective case series analyzed clinical data from 110 consecutive pancreaticoduodenectomy patients who underwent "2+3" pancreaticojejunostomy, performed by a single surgeon at Qilu Hospital of Shandong University between December 2022 and July 2025. The cohort comprised 61 males and 49 females, with an age of (60.9±10.9) years (range: 21 to 83 years). Four patients (3.6%) received neoadjuvant therapy preoperatively. The technique features a modified duct-to-mucosa anastomosis: the "2" denotes a double-layer continuous suture of the anterior and posterior pancreatic parenchyma to the jejunum using 4-0 non-absorbable suture, with the posterior line incorporating the dorsal pancreatic duct wall and the jejunotomy; the "3" signifies three interrupted duct-to-mucosa sutures placed at the 6, 12, and 3 o'clock positions using 4-0 absorbable suture. Clinical and pathological data were compared using Student's t-test, Mann-Whitney U test, χ² test, or Fisher's exact test. Results: The overall postoperative complication rate was 20.0% (22/110), with a 9.1% (10/110) incidence of clinically relevant postoperative pancreatic fistula (CR-POPF). No instances of grade C postoperative pancreatic fistula, reoperations, or perioperative deaths occurred. The postoperative hospital stay was (13.6±4.0) d (range: 7 to 27 d). The pathological types included pancreatic cancer (n=54, 49.1%), duodenal cancer (n=29, 26.4%), distal cholangiocarcinoma (n=10, 9.1%) and other tumors (n=17,15.5%). Patients were categorized based on surgical approach into laparoscopic pancreaticoduodenectomy (LPD) (n=44) and open pancreaticoduodenectomy (OPD) (n=66) groups. There was no statistically significant difference in the CR-POPF rate between the LPD group and the OPD group (15.9% (7/44) vs. 4.5% (3/66), P=0.086). Based on pancreatic duct diameter, patients were divided into a non-dilated duct group (n=79) and a dilated duct group (n=31). Compared with the dilated duct group(0 (0/31)), the CR-POPF incidence in the non-dilated duct group(12.7% (10/79)) showed no statistically significant difference (P=0.059). There were no statistically significant differences in operative time, intraoperative blood loss, CR-POPF rate, or postoperative hospital stay between patients with soft pancreas (n=68) and hard pancreas (n=42) (P>0.05). Conclusion: The "2+3" pancreaticojejunostomy technique for pancreatic reconstruction during pancreaticoduodenectomy is effective and reliable.

PMID:
42350893
Bibliographic data and abstract were imported from PubMed on 26 Jun 2026.

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