Association of a Modified Blumgart Anastomosis With the Incidence of Pancreatic Fistula and Operation Time After Laparoscopic Pancreatoduodenectomy: A Cohort Study

Abstract

Objective: To explore the association between a modified Blumgart anastomosis technique and the operative time and surgical complications.

Methods: This is a retrospective cohort study that analyzed the data of patients who underwent laparoscopic pancreaticoduodenectomy from January 2015 to March 2021. The primary outcome was to explore the association between the modified Blumgart anastomosis technique and operative time.

Results: A total of 282 patients were enrolled. There were 177 cases of pancreatic duct-to-mucosa anastomosis in the traditional surgery group, and 105 cases of the modified three-step Blumgart anastomosis in the modified group. There were no statistically significant differences in the general and intraoperative characteristics found between the two groups (P > 0.05). The surgical method was an independent predictor of operative time. Overall complications postsurgery were less common in the modified group than in the traditional group. The incidence of postoperative pancreatic fistula was higher in the traditional group than in the modified group (45 cases (25.4%) and 11 cases (10.5%), respectively). Fourteen cases (7.9%) in the traditional group and four case (3.8%) in the modified group had postoperative pancreatic fistula of grades B + C. The two groups had statistically significant differences (P < 0.05). The results of the linear regression showed that the type of surgical method was associated with operation time (95% CI, -73.074 to -23.941, β: -0.438, P < 0.001).

Conclusion: This modified three-step Blumgart pancreaticojejunostomy was associated with the operation time.

Keywords: POPF; blumgart anastomosis; laparoscopic pancreatoduodenectomy; operation time; pancreaticojejunostomy.

Figure 1

Schematic diagram of the modified Blumgart anastomosis. Step 1 (A–D): suturing of the posterior wall of the pancreas and jejunum. In steps (A,B) the superior border of the pancreas was penetrated. Then, the seromuscular layer of the jejunum was sutured and knotted. Step c shows the suturing and fixing of the superior border of the pancreas from the top to bottom through the entire pancreas and the suturing of the jejunum. Step 2 (E–H): the 8-shaped pancreaticojejunostomy anastomosis suture. Step (D) shows a small opening on the jejunum side made for the anastomosis. Step (E) shows the first 8-shaped stitch on the posterior wall of the pancreaticojejunostomy. Steps (F,G) show the 8-shaped sutures of the second and third stitches. Step (I) shows that the inferior border of the pancreas was penetrated through the complete layer. Then, the seromuscular layer of the jejunum was sutured and knotted with the unknotted suture in Step 1. Step 3 (K,L): the anterior wall of the pancreas was sutured with the seromuscular layer of the jejunum.