Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study.

Abstract

BACKGROUND:

Postoperative pancreatic fistula (POPF) is the main cause of fatal complications after pancreatoduodenectomy. There is still no universally accepted technique for pancreaticoenterostomy, especially in patients with soft pancreas.

METHODS:

Between July 2008 and June 2013, 240 patients who underwent pancreatoduodenectomy were enrolled in this single-institution matched historical control study. To approximate the pancreatic parenchyma to the jejunal seromuscular layer, 120 patients underwent anastomosis using the Kakita method (three or four interrupted penetrating sutures) and 120 underwent anastomosis using the modified Blumgart anastomosis (m-BA) method (one to three transpancreatic/jejunal seromuscular sutures to completely cover the pancreatic stump with jejunal serosa).

RESULTS:

The rate of clinically relevant POPF formation was significantly lower in the m-BA group than that in the Kakita group (2.5 vs 36 %; p < 0.001). The duration of drain placement and the length of postoperative hospital stay were significantly shorter in the m-BA group. Multivariate analysis showed that m-BA was an independent predictor of non-formation of POPF (hazard ratio, 0.02; 95 % confidence interval, 0.01-0.08; p < 0.001).

CONCLUSION:

The m-BA method is safe and simple and improves postoperative outcomes. We suggest that the m-BA is suitable for use as a standard method of pancreaticojejunostomy after pancreatoduodenectomy.

• Authors: Tsutomu Fujii, Hiroyuki Sugimoto, Suguru Yamada, Mitsuro Kanda, Masaya Suenaga, Hideki Takami, Masashi Hattori, Yoshikuni Inokawa, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera
• Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (J Gastrointest Surg) Vol. 18 Issue 6 Pg. 1108-15 (Jun 2014) ISSN: 1873-4626 [Electronic] United States
• PMID: 24733259 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Amylases

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Amylases (analysis)
• Anastomosis, Surgical (adverse effects, methods)
• Drainage
• Female
• Humans
• Jejunum (surgery)
• Length of Stay
• Male
• Middle Aged
• Pancreas (surgery)
• Pancreatic Fistula (etiology)
• Pancreatic Neoplasms (surgery)
• Pancreaticoduodenectomy (adverse effects, methods)
• Suture Techniques
• Time Factors
• Young Adult