A modified stent-free Chen's U-suture technique in pediatric pancreaticojejunostomy: safety and efficacy.
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BACKGROUND: Pediatric pancreatic surgery is challenging due to soft pancreatic texture and small main pancreatic duct (MPD) diameter, both risk factors for postoperative pancreatic fistula (POPF). The modified stent-free Chen's U-suture technique, a continuous transpancreatic U-shaped invagination pancreaticojejunostomy without stenting, has shown low clinically relevant POPF (CR-POPF) rates in adults. This study evaluates its safety and feasibility in children. METHODS: From July 2018 to November 2025, five children (2 males, 3 females; aged 4.3-10.1 years) underwent pancreatic resection with the modified stent-free Chen's U-suture technique (no MPD stent placement). Diagnoses included pancreatic head solid pseudopapillary neoplasm (SPN, n = 2, one with jaundice), body SPN (n = 1), grade III trauma (n = 1), and complex iatrogenic injury (n = 1). The primary endpoint was POPF rate (ISGPS 2016). RESULTS: All procedures were successful. Median operative time was 5 h (range 3-8); mean pancreaticojejunostomy time 17.8 min (15-21); median blood loss 50 mL (20-100). Two patients had transient mild hyperamylasemia (< 2×upper limit of normal) with imaging showing localized perianastomotic edema/fluid collection without diffuse parenchymal edema or necrosis, managed conservatively. One patient met the criteria for a biochemical leak; no CR-POPF (0%, 95% CI: 0.0%-52.2%) (grade B/C) occurred. No infection, hemorrhage, reoperation, or readmission occurred. Drains were removed on days 5-14 (median, 7 days). At median 25-month follow-up (range 4-92), one child required pancreatic enzyme replacement for fat malabsorption 4 years post-surgery; no new diabetes or other malabsorption occurred. One patient had asymptomatic mild distal MPD dilatation (2.9 mm) at 25 months; another had normal MPD shape (2.3 mm) at 4 months. CONCLUSION: The modified stent-free Chen's U-suture technique demonstrates promising feasiblility and safety for pediatric pancreatic head, neck, or body tumor resection, grade III trauma, and complex iatrogenic injuries, achieving a 0% CR-POPF rate in this small cohort (95% CI: 0.0%-52.2%) without the need for internal stenting. Transient mild hyperamylasemia with localized perianastomotic inflammatory changes is uncommon and manageable. Long-term pancreatic function is generally preserved, though asymptomatic MPD dilatation may occur.