The improvement of pancreatic duct stent tube in internal drainage during pancreaticojejunostomy—surgical technique

The success of pancreaticojejunostomy (PJ) critically depends on achieving optimal pancreatic juice drainage. Clinical evidence demonstrates that internal stent placement is highly safe and effective in reducing postoperative complications associated with PJ. However, recent clinical observations have raised concerns regarding potential complications following pancreatic duct stent placement, including intestinal wall perforation caused by the stent. This study aims to describe the design and step-by-step use of a bulb-tipped internal pancreatic duct stent during PJ and to report short-term postoperative outcomes in a consecutive single center series (January 2021-January 2023). The clinical data of 33 patients who underwent PJ with the improved tube from January 2021 to January 2023 were reviewed. General information (gender, age, underlying disease), operation-related information (intraoperative blood loss, postoperative complications, postoperative hospital stay, prognosis) and postoperative diagnosis were retrospectively analyzed. All patients, with a median age of 60 (range, 46-75) years, 18 males and 15 females, underwent PJ successfully, and the improved duct stent was successfully placed during the operation. The median intraoperative blood loss was 100 (range, 50-700) mL. Postoperative complications were observed in 16 patients (48.5%). Among them, a total of 5 patients (15.2%) experienced Grade B/C postoperative pancreatic fistula (POPF). The specific types of complications were as follows: Grade A POPF (n=11, accounting for 33.3%), Grade B POPF [n=4, accounting for 12.1%; among which there were 3 cases of delayed gastric emptying (DGE) and 1 case of surgical site infection], and Grade C POPF (n=1, accounting for 3.0%). Notably, no stent-related complications occurred (0%; 95% confidence interval: 0.0-10.6%). The median postoperative hospitalization was 15 (range, 12-38) days. Among the 31 patients (93.9%) who completed the 3-month follow-up, two cases (6.1%) were lost to follow-up. Preliminary findings suggest that the optimized pancreatic duct stent exhibits favorable early-stage safety in current clinical applications. No stent-related complications were detected within this cohort. As further research progresses, this improved medical device holds promise for demonstrating broader clinical utility and substantial potential in enhancing patient treatment efficacy.