Expert Survey on Chyle Leakage After Pancreaticoduodenectomy: The Precision Anatomy for Minimally Invasive Hepato-Biliary-Pancreatic Surgery (PAM-HBP Surgery) Project 2024

Abstract

Background/Purpose Chyle leakage (CL) after pancreaticoduodenectomy (PD) remains an underestimated complication with a consistent incidence. This expert survey analyzed its occurrence from anatomical and surgical perspectives. Methods: A structured survey was distributed to 57 surgeons from 10 countries, with extensive experience in open and minimally-invasive pancreatectomy. Results: Most experts reported CL incidence as: open >= laparoscopic, open > robotic, and laparoscopic = robotic. They identified three major anatomical pitfalls: (i) the transverse mesocolon on the ventral side of the superior mesenteric artery and vein (SMA/SMV), (ii) the meso-jejunum on the dorsal side of the SMA/SMV, and (iii) the fusion fascia of Treitz on the ventral side of the inferior vena cava (IVC). For lymphatic dissection and control, energy devices were favored across all approaches, whereas ligation was more common in open PD and clipping more frequent in robotic PD. Opinions on the optimal dissection plane at the fusion fascia of Treitz varied: along the pancreatic surface (21%), within the fascia (31%), or exposing the IVC (38%). Conclusions Expert opinions suggest that the incidence of CL after PD does not differ significantly between open and minimally invasive approaches. Consensus emerged regarding common anatomical pitfalls, which may inform strategies for prevention.