Background and Aims: Laparoscopic pancreaticoduodenectomy (LPD) is one of the most complex operations in general surgery, characterized by long operative time, difficult resection, numerous anastomoses and high incidence of complications. Particularly, the postoperative pancreatic fistula (POPF) following LPD, which may cause the abdominal infection, bleeding and even death seriously restrict further development and application of this technique. Therefore, the avoidance of POPF has become an urgent problem to be solved. The authors previously have applied the continuous penetrating-suture pancreaticojejunostomy in LPD, which yielded satisfying results, but still has some limitations. So, this study was conducted to further observe the clinical efficacy of using the modified continuous penetrating-suture pancreaticojejunostomy in LPD. 
Methods: Twenty-five patients admitted to Yijishan Hospital from June 2017 to December 2019 for LPD were randomly divided into two groups, and underwent continuous penetrating-suture pancreaticojejunostomy (control group, 15 cases) or modified continuous penetrating-suture pancreaticojejunostomy (observation group, 10 cases) during LPD, respectively. The latter was namely that 2 U-shaped sutures were performed on the cut surface of the pancreas to reinforce the cut surface of the pancreas prior to performing the continuous penetrating-suture pancreaticojejunostomy. The main clinical variables between the two groups of patients were compared.
Results: There was no significant difference in each preoperative variable between the two groups of patients (all P>0.05). LPD was successfully completed in all the 25 patients. There were no significant differences in the average operative time and intraoperative blood loss between the two groups (both P>0.05), but the average operative time for pancreaticojejunostomy in observation group was significantly longer than that in control group (23.50 min vs. 20.20 min, P=0.003). There was no significant difference in the overall incidence of pancreatic fistula between the two groups (P>0.05), but the incidence of grade B pancreatic fistula in observation group was significantly lower than that in control group (0 vs. 40%, P=0.028); the overall incidence of other postoperative complications such as abdominal infection and bleeding was lower in observation group than that in control group, but the difference did not reach a statistical significance (0 vs. 33.3%, P=0.057); the time for removal of the drainage tube placed near the pancreaticojejunostomy (11.00 d vs. 25.60 d, P<0.001) and length of hospital stay (12.20 d vs. 18.53 d, P=0.045) in observation group were significantly shorter than those in control group.
Conclusion: Modified penetrating-suture pancreaticojejunostomy is a simple and convenient method, and its application in LPD is safe and reliable, which not only reduces the incidence of grade B pancreatic fistula, but speeds up the postoperative recovery of the patients. So, it is recommended to be widely used in clinical practice.