LPD was performed on the patient lying on his back, with his legs separated and in a slight anti-Trendelenburg position. A holder of the mirror stood between the legs, with an operator and an assistant on either side of the patient. A total of 5 trocars were placed. Three trocars with a diameter of 12 mm were located about 5 cm below the umbilicus and on the left and right sides of the umbilicus, respectively. Two 5 mm trocars were placed in the left and right epigastrium. Except 2 cases with Olympus 3D laparoscopy, the rest were performed with 30° 2D laparoscopy.
All cases underwent partial distal gastrectomy without preserving pylorus. Patients with malignant tumors underwent lymph node dissection, including duodenal ligament, common perihepatic artery, peripancreatic head, celiac trunk, and left superior mesenteric artery lymph nodes. Concomitant portal vein and/or superior mesenteric vein (PV/SMV) resection is performed on patients with possible or definite tumor invasion. The reconstruction process was carried out by a “CHILD” method. The upper intestinal segment was lifted to the subhepatic portion through the mesenteric root. First, pancreaticoenterostomy was performed at about 5 cm away from the ruptured end of the jejunum. Second, choledochojejunostomy was performed at about 5-15 m away from the position of pancreaticoenterostomy. When the diameter of bile duct was ≥1.0 cm, 4-0 V-Loc was used for end-to-end anastomosis of bile duct and jejunum; when the diameter of the bile duct was less than 1.0 cm, 4-0 Monocryl suture was used for intermittent suture and placed internal stents. Finally, the gastrojejunal side-to-side anastomosis was performed before the colon. A drainage tube was placed in front of and behind the pancreaticoenterostomy site.
All cases underwent partial distal gastrectomy without preserving pylorus. Patients with malignant tumors underwent lymph node dissection, including duodenal ligament, common perihepatic artery, peripancreatic head, celiac trunk, and left superior mesenteric artery lymph nodes. Concomitant portal vein and/or superior mesenteric vein (PV/SMV) resection is performed on patients with possible or definite tumor invasion. The reconstruction process was carried out by a “CHILD” method. The upper intestinal segment was lifted to the subhepatic portion through the mesenteric root. First, pancreaticoenterostomy was performed at about 5 cm away from the ruptured end of the jejunum. Second, choledochojejunostomy was performed at about 5-15 m away from the position of pancreaticoenterostomy. When the diameter of bile duct was ≥1.0 cm, 4-0 V-Loc was used for end-to-end anastomosis of bile duct and jejunum; when the diameter of the bile duct was less than 1.0 cm, 4-0 Monocryl suture was used for intermittent suture and placed internal stents. Finally, the gastrojejunal side-to-side anastomosis was performed before the colon. A drainage tube was placed in front of and behind the pancreaticoenterostomy site.
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