Background : Pancreatic fistula is one of the most important complications that can develop following PD. Various studies in the literature report a wide range of POPF rates, ranging from 13% to 45%. Although new techniques and studies have been developed over the last 30 years to reduce POPF, a satisfactory improvement in fistula rates has not yet been achieved

Methods : From 2021, laparoscopic PD using laparoscopic dunking (invagination) PJ with trans-pancreatic suture was performed for about 2 years, and analysis was conducted based on 20 cases.

Results : The average age of the patients was 65.8 years, and 9 patients (45%) were male. Most of the patients (n=14, 70%) underwent surgery for cancer, and the average operation time was skin to skin 8 hours 30 minutes. Excluding meal time, it was about 8 hours. Among them, the PJ anastomosis time was about 53 minutes. The average pancreatic duct size was 3.5 mm, and most were soft pancreas (90%). Most of the POPF grades (90%, 18 patients) according to the 2016 ISGPS after surgery were no fistula or grade A. However, the complication of the remaining two patients was GDA stump bleeding, and one was successfully resolved with angiographic embolization (Grade B), and the other died due to failure of embolization (Grade C).

Conclusions : Laparoscopic dunking (invagination) PJ with trans-pancreatic suture has the advantage of shortening the time and reducing the burden on small duct size, but there are also disadvantages. Therefore, current abstract was submitted to discuss the opinions of experts.