Impact of Modified Blumgart Anastomosis on Pancreatic Fistula and Pancreaticojejunostomy Time During Laparoscopic Pancreaticoduodenectomy: Single-Center Experience

Abstract

Background/Objectives: The aim of this study is to evaluate the impact of modified Blumgart anastomosis methods during pancreaticojejunostomy (PJ) on the incidence of clinically relevant postoperative pancreatic fistula (POPF) after laparoscopic pancreaticoduodenectomy (LPD). Methods: This is a retrospective cohort study analyzing data of patients who underwent LPD from 2018 to 2022. The primary endpoint was the incidence of grade B and C POPF based on the International Study Group on Pancreatic Fistula criteria and PJ anastomosis time. Incidence of postoperative complications (Clavien-Dindo classification grade ≥ III) was also investigated. Results: A total of 148 patients, 99 patients in a modified Blumgart group and 49 patients in a continuous suture group, were enrolled. There were no statistically significant differences in the general and intraoperative characteristics found between the two groups (p > 0.05). There was no significant difference in pancreas texture (p = 0.397) and diameter of pancreatic duct (p = 0.845). Grade B and C POPF occurred in five patients (5.1%) in the modified Blumgart group and three patients (6.1%) in the continuous suture group with no statistical difference (p = 0.781). A total of eleven patients (11.1%) in the modified Blumgart group and four patients (8.2%) in the continuous suture group had postoperative complication (Clavien-Dindo Classification grade 3 or more). Mortality within 90 days was 2 (2%) and 0 (0%), respectively. The PJ anastomosis times in the modified Blumgart group and continuous suture group were 28.8 ± 5.94 min and 35 ± 7.71 min, respectively (p = 0.003). Conclusions: This study suggests that modified Blumgart PJ showed shorter anastomosis time with comparable outcome to continuous suture methods in LPD.

Keywords: POPF; anastomosis; laparoscopic; pancreaticoduodenectomy; pancreaticojejunostomy.

Figure 1

Intraoperative images of the reconstruction of PJ anastomosis with modified Blumgart technique in LPD. (a): Transpancreatic suture through full-thickness pancreas to seromuscular jejunum using 3-0 Prolene with needle straightened. (b): Suture of posterior seromuscular wall of jejunum parallel to the long axis of the jejunum. (c): Tie the suture and approximation of jejunum to pancreas. (d): Opening of jejunum and duct-to-mucosa anastomosis with internal stent. 5-0 PDS interrupted suture was used. (e): Completion of duct-to-mucosa anastomosis. (f): Additional full-thickness pancreas suture caudal to pancreatic duct (g): Suture of anterior seromuscular wall of jejunum perpendicular to the long axis of the jejunum. (h): Anterior seromuscular jejunum suture cranial to pancreatic duct. (i): Completion of modified Blumgart pancreaticojejunostomy after interrupted reinforcing suture of anterior side. (j): Coronal view after modified Blumgart PJ anastomosis.

Figure 2

Postoperative follow-up period (days).