The patients who underwent LPD applying the procedure of wrapping around the PJ in the Second Affiliated Hospital of Chongqing Medical University between January 2018 and December 2022 were retrospectively analyzed. Of these, we have started to routinely use the LTH to wrap around the PJ after November 2021, while this method has not been done before. Preoperative biochemical and imaging examinations (CT/MRI) were routinely performed in all patients, and all clinical data were collected retrospectively. Prophylactic antibiotic therapy was intravenously administered 30 min before surgery and maintained until the seventh postoperative day for regular patient, the type, dose and course of antibiotic therapy will be adjusted according to the real-time changes in patients’ condition. Warm glucose saline was slowly injected through the gastric tube on the first day, and “nourishing enteral nutrition” was started on the third day under the guidance of a clinical dietitian. Post-operative management included hematischesis, inhibition of pancreatic enzymes, rehydration, acid suppression and stomach protection, analgesia and other symptomatic and supportive care.

All individual participant included in this study had signed informed consent for reviewing and researching their anonymized clinical data. This study has been approved by the Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University.

POPF [5], delayed gastric emptying (DGE) [11], and PPH [12] were defined according to the International Standard of Research Group of Pancreatic Fistula (ISGPF).

The following variables were retrospectively reviewed and analyzed: 1) The preoperative data included age, gender, body mass index (BMI), comorbidity, routine preoperative laboratory examination, Pancreatic CT value, pancreatic tube diameter and American Society of Anesthesiologists (ASA) score. The intraoperative data comprised information on the length of operative time, blood loss. The postoperative data mainly included postoperative complications PPH, POPF, biliary leakage, diarrhoea and DGE, the Clavien–Dindo classification, intra-abdominal infection, bowel obstruction, 30-day mortality, R0 resection, harvested lymph nodes and positive lymph nodes.

The pancreatic stump was exposed in the visual field, and the LTH was mobilized around the pancreatic stump (Fig. 1A). A silicone catheter was inserted into the main pancreatic duct as an internal stent. The modified Blumgart’s method [13] used two transpancreatic-LTH-jejunal seromuscular U-shaped sutures to approximate the pancreas, LTH and the jejunum. The LTH was fixed behind the pancreatoenteric anastomosis (Fig. 1B, C). a hole was created in the jejunum using the electronic coagulator (Fig. 1D), and the other end of the silicone tube was inserted into the lumen of the jejunal intestine. The figure-eight suture was carried out for the posterior wall of the anastomosis between the posterior wall of the main pancreatic duct and the full layer of the jejunu, and this layer used only two to four sutures. the anterior wall of anastomosis was completed between the anterior wall of the main pancreatic duct and the anterior wall of the jejunum, and this layer used three to five sutures using same suture manner (Fig. 1E). The LTH was used to cover the upper and inferior margin of pancreatoenteric anastomosis (Fig. 1F, G). The ventral and dorsal view of the wrapped pancreatoenteric anastomosis (Fig. 1H, I). Diagram of wrapping PJ technique is shown in Fig. 2.

Wrapping technique of the PJ. A The pancreatic stump and the LTH stump were exposed in the visual field. B, C The modified Blumgart’s method used two transpancreatic-LTH- jejunal seromuscular U-shaped sutures to approximate the pancreas, LTH and the jejunum. The LTH was fixed behind the pancreatoenteric anastomosis. D The location of the pancreatoenteric anastomosis was marked on the jejunum. E The duct-to-mucosa PJ technique was used to draining pancreatic juice into the intestinal lumen. F, G The LTH was used to cover the upper and inferior margin of pancreatoenteric anastomosis. H, I The ventral and dorsal view of the wrapped pancreatoenteric anastomosis

Diagram of wrapping PJ technique. A Two transpancreatic-LTH- jejunaluscular U-shaped sutures were employed to approximate the pancreas and jejunum, with the LTH serving as a pad for wrapping the posterior wall of the PJ. B Three to five transpancreatic—duct—jejunum full-thickness figure-eight sutures was used to complete the duct-to-mucosa PJ. C One transpancreatic-LTH- jejunaluscular interrupted suture was used to cover the superior and inferior margin of PJ separately

Propensity score matching analysis was performed to eliminate confounding variables between the two cohorts. This analysis matched variables that were significantly different between the twocohorts and variables that might have an impact on the postoperative outcome, including CEA, pancreatic CT value, and pancreatic tube diameter. Numerous studies have been conducted on the CT value of the pancreas as an objective indicator of pancreatic texture (firm or soft), rather than relying on subjective evaluations, the CT value of the pancreas and the diameter of the pancreatic duct were closely related to the occurrence of POPF [14,15,16], so we performed PSM. CEA varied between the groups in this study, and to eliminate its interference with the study, we also performed PSM. Furthermore, it is noteworthy that all surgical procedures were conducted by the same surgeon, all patients had pancreatic duct stenting, uniform suture methods were employed throughout, and there was no significant statistical difference between SEX and BMI between the two cohorts. Consequently, these variables were excluded from PSM in our study. A matching caliper of 0.02 and 1:1 nearest neighbor matching was used in this matching analysis.

This study used SPSS 26.0 software (IBM, Chicago, IL, USA). Baseline data, Intraoperative variables, and Postoperative variables between the two cohorts were performed by using descriptive statistics. Mean and standard deviation (SD) were used to describe the variables meeting the normal distribution. Variables that did not fit the normal distribution were described by using the median and interquartile range (IQR). Categorical variables were summarized by using counts and percentages. Before PSM, comparisons between the two cohorts were finished by using the independent samples t-test to compare parametric variables, using the Mann–Whitney U test to compare nonparametric variables, and using the Chi-square test to compare categorical variables. After PSM, comparisons between the two cohorts were finished by using the paired t-test to compare parametric variables, using the Wilcoxon rank-sum test to compare nonparametric variables, and using the MeNemar test to compare categorical variables. Univariate and multivariate logistic regression analyses were performed to identify the independent predictors of POPF. A P value less than 0.05 was defined as statistical significance.