The surgical outcomes of modified Chen’s U-suture technique compared with duct-to-mucosa anastomosis in laparoscopic pancreaticoduodenectomy: a multi-center cohort study

Since being reported in 2014 with a low clinically relevant postoperative pancreatic fistula (CR-POPF) rate, Chen’s U-suture technique has undergone multiple modifications. This study aims to compare the surgical outcomes of the modified Chen’s U-suture technique with duct-to-mucosa anastomosis in laparoscopic pancreaticoduodenectomy (LPD).

Data on 669 consecutive patients treated with LPD in 8 tertiary medical centers from January 2021 to December 2024 were retrospectively collected and classified into Chen’s group (n = 276) and duct-to-mucosa group (n = 393) according to different pancreaticojejunostomy. Propensity score matching (PSM) analysis was performed to balance the baseline differences. The surgical outcomes were compared.

After PSM, 208 patients in each group with balanced baseline characteristics were matched. The mean duration of pancreaticojejunostomy was 16.87 ± 6.20 min in Chen’s group compared to 21.74 ± 13.82 min in the duct-to-mucosa group (p < 0.001). The mean length of postoperative hospital stay was shorter in Chen’s group (10.07 ± 8.17 days vs. 13.19 ± 11.42 days, p = 0.002). There were 14 patients (6.73%) in Chen’s group and 22 patients (10.58%) in the duct-to-mucosa group who developed CR-POPF (p = 0.222); and 2 patients (0.96%) in Chen’s group and 8 patients (3.85%) in the duct-to-mucosa group occurred 90-day mortality (p = 0.109). No significant differences were observed between the two groups in the severe complication rates, re-operation rates, and re-hospitalization rates. In the subgroup with main pancreatic duct ≤ 3 mm, the duration of pancreaticojejunostomy and the length of postoperative hospital stay were shorter, and the severe complication rates as well as 90-day mortality rates were lower in Chen’s group (all p < 0.05).

The modified Chen’s U-suture technique is a simple, fast, and reliable alternative to duct-to-mucosa anastomosis in LPD, particularly in cases with a main pancreatic duct ≤ 3 mm.