Comparison of Modified Blumgart pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy

Abstract

Background: The aim of this study was to compare perioperative outcomes after Blumgart pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) for pancreatic-enteric reconstruction following pancreaticoduodenectomy.

Methods: Data of patients undergoing Blumgart PJ and PG were retrieved from prospectively-collected database. Matched patients in each surgical groups were included based on the Callery risk scoring system for clinically relevant postoperative pancreatic fistula (CR-POPF) (grades B and C). Surgical parameters and risks were compared between these two groups.

Results: A total of 206 patients undergoing PD were included. Blumgart PJ was associated with shorter postoperative hospital stay (median (range) 25 (10-99) vs. 27 (10-97) days, P = 0.022). There was no surgical mortality in the Blumgart PJ group, but a 4.9% perioperative mortality in the PG, P = 0.030. The CR-POPF by Blumgrt PG is significantly lower than that by PG for overall patients (7% vs. 20%, P = 0.007), especially for those in intermediate fistula risk zone (6% vs. 21%, P =0.048) and high fistula risk zone (14% vs. 47%, P=0.038).

Conclusions: Blumgart PJ is superior to PG in terms of pancreatic leakage and surgical mortality. Blumgart PJ can be recommended for pancreatic reconstruction after PD for all pancreatic remnant subtypes.

Figure 1

Modified Blumgart pancreaticojejunstomy. (a-1 and a-2) Pre-set outer layer U-sutures for transpancreatic and posterior horizontal mattress suturing on jejunum without tying to allow a room for easy, accurate and reliable placement of inner layer interrupted sutures; (b-1 and b-2) Pre-set inner layers interrupted sutures for duct-to-mucosa anastomosis; (c-1 and c-2) Tied and completed inner layer sutures for duct-to-mucosa anastomosis; (d-1 and d-2) Outer layer U-sutures for anterior horizontal mattress suturing on jejunum; (e-1 and e-2) Tied and completed outer layer U-sutures