Background : Laparoscopic pancreaticoduodenectomy (PD) is one of the most technically challenging procedures to be done minimally invasive, more so because of the need to reconstruct the alimentary system. The pancreatic-jejunostomy (PJ) is technically challenging, and pancreatic fistula is the most common complication post-PD, occurring in around 12% to 18% of patients, necessitating the performance of a standardised and replicable technically sound anastomosis. Duct-to-mucosa PJ is the commonly performed type of PJ, and in this video, we demonstrate our technique for performing a laparoscopic PJ using ArtiSential instruments for the duct-to-mucosa anastomosis.

Methods : The anastomosis includes sero-muscular sutures and duct-to-mucosa stitches. We began by taking the posterior seromuscular sutures, and an adequate number of stitches are taken to make the remnant pancreas snugly fit with the jejunum. A couple of anterior seromuscular stitches are taken at the farther corner. Duct-to-mucosa stitches are taken first posteriorly and then in the farther corner. The duct is then stented, and stitches are then taken at the near corner and anteriorly to finish the duct-to-mucosa anastomosis. Around 5-6 duct-to-mucosa stitches are taken. ArtiSential was used for the duct-to-mucosa stitches as the articulation increased the ease of suturing. The anterior seromuscular stitches were then completed. Prolene was used for suturing.

Results : The anastomosis took around 70 minutes to complete. The patient had a smooth post-operative recovery and was discharged on POD 8.

Conclusions : Laparoscopic PJ is technically challenging and should be standardised for optimal outcomes. ArtiSential may increase the ease of doing the procedure.