Single-suture parachute technique for hepaticojejunostomy in laparoscopic pancreatoduodenectomy: a multicenter, large-scale study

The optimal technique for hepaticojejunostomy (HJ) during laparoscopic pancreatoduodenectomy (LPD) remains debated. This multicenter, single‑arm study aimed to evaluate the safety, feasibility, and reproducibility of the single‑suture parachute technique for HJ (SSPT‑HJ) in LPD. We analyzed the demographic characteristics and perioperative outcomes of patients who underwent LPD using the SSPT-HJ between January 2019 and December 2023. Propensity score matching (PSM) was employed to compare surgical outcomes stratified by bile duct diameter (≤ 0.8 cm vs. >0.8 cm) and suture type (non-absorbable polypropylene vs. absorbable polydioxanone). A total of 689 patients who underwent SSPT-HJ were enrolled. The median operative time was 295.0 min (IQR 240.0-370.0), with a notably short median HJ time of 11.0 min (IQR 10.0–14.0). The overall incidence of bile leakage was 8.9%, while clinically relevant postoperative pancreatic fistula (CR-POPF, combined Grade B and C) occurred in 12.5% of patients (Grade B: 8.6%; Grade C: 3.9%). Major morbidity (Clavien-Dindo grade ≥ III) was observed in 16.3% of cases. The 90-day mortality rate was 3.2%. Following PSM, no statistically significant differences were found between groups stratified by bile duct diameter or suture type. The SSPT‑HJ demonstrates high feasibility, safety, and reproducibility in LPD, with postoperative complication rates comparable to published benchmarks—regardless of bile duct diameter or suture material.