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Comparative Study
. 2018 Oct 24;18(1):88.
doi: 10.1186/s12893-018-0420-5.

Comparison of pancreatojejunostomy techniques in patients with a soft pancreas: Kakita anastomosis and Blumgart anastomosis

Shoji Kawakatsu  1 , Yosuke Inoue  1 , Yoshihiro Mise  1 , Takeaki Ishizawa  1 , Hiromichi Ito  1 , Yu Takahashi  1 , Akio Saiura  2
Affiliations
Comparative Study

Comparison of pancreatojejunostomy techniques in patients with a soft pancreas: Kakita anastomosis and Blumgart anastomosis

Shoji Kawakatsu et al. BMC Surg. .

Abstract

Background: Postoperative pancreatic fistula (PF) is the main cause of operative mortality in patients who undergo pancreatoduodenectomy. Various pancreatoenteric anastomosis techniques have been reported to minimize the postoperative PF rate. However, the optimal method remains unknown. This study was performed to clarify the impact of pancreatojejunostomy on clinically relevant PF (CR-PF) between Blumgart anastomosis and Kakita anastomosis in patients with a soft pancreas.

Methods: In total, 620 consecutive patients underwent pancreatoduodenectomy at our institute from January 2010 to December 2016, and 282 patients with a soft pancreas were analyzed (Blumgart anastomosis, n = 110; Kakita anastomosis, n = 176). Short-term outcomes were assessed, and univariate and multivariate analyses of several clinicopathological variables were performed to analyze factors affecting the incidence of CR-PF.

Results: The CR-PF rate was 42.7% (122/286). The CR-PF rate was not significantly different between the Blumgart and Kakita groups (42.7% and 42.6%, respectively; p = 0.985). The morbidity rate (Clavien-Dindo grade ≥ IIIa) was 24.5% (70/286), and the operation-related mortality rate was 0.7% (2/286). In the multivariate analysis, male sex (p = 0.0245) and a body mass index of ≥22 kg/m2 (p < 0.0001) were statistically significant risk factors for CR-PF.

Conclusions: The CR-PF rate was not significantly different between patients treated with Kakita versus Blumgart anastomosis.

Keywords: Pancreatic fistula; Pancreatoduodenectomy; Pancreatojejunostomy.

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Conflict of interest statement

Ethics approval and consent to participate

This study protocol was reviewed and approved by the Ethics Committee of the Cancer Institute Hospital, Japanese Foundation for Cancer Research on June 1, 2018. Registration number: 2017–1184.

Informed consent was waived by the Ethics Committee of the Cancer Institute Hospital, Japanese Foundation for Cancer Research.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of patient allocation
Fig. 2
Fig. 2
Pancreatojejunostomy method. Eight interrupted sutures with single-armed 6–0 polydioxanone for anastomosis of the main pancreatic duct to the jejunal mucosal layer (omitted from this schema) and several interrupted sutures with double-armed 3–0 polydioxanone for anastomosis of the pancreatic parenchyma to the jejunal seromuscular layer [(a) modified Kakita anastomosis or (b) modified Blumgart anastomosis]
See this image and copyright information in PMC

References

    1. Kimura W, Miyata H, Gotoh M, Hirai I, Kenjo A, Kitagawa Y, et al. A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg. 2014;259(4):773–780. doi: 10.1097/SLA.0000000000000263. - DOI - PubMed
    1. Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220(4):530–536. doi: 10.1016/j.jamcollsurg.2014.12.031. - DOI - PubMed
    1. Yekebas EF, Wolfram L, Cataldegirmen G, Habermann CR, Bogoevski D, Koenig AM, et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg. 2007;246(2):269–280. doi: 10.1097/01.sla.0000262953.77735.db. - DOI - PMC - PubMed
    1. Kakita A, Takahashi T, Yoshida M, Furuta K. A simpler and more reliable technique of pancreatojejunal anastomosis. Surg Today. 1996;26(7):532–535. doi: 10.1007/BF00311562. - DOI - PubMed
    1. Brennan M. Pancreatojejunostomy. In Blumgart LH, Fong Y, eds. Surgery of the liver and biliary tract, 3rd ed. Philadelphia: Saunders, 2000;pp1073–89.

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