Does the modified blumgart anastomosis improve the outcomes of pancreaticojejunostomy in patients with carcinoma of the papilla of vater?

Abstract

Background: Recently, some studies have shown that the modified Blumgart anastomosis (m-BA) for pancreaticojejunostomy is associated with a low postoperative pancreatic fistula (POPF) rate after pancreatoduodenectomy (PD). Patients with carcinoma of the papilla of Vater are likely to have soft pancreas which is a risk factor of POPF. The aim of this study was to evaluate whether m-BA reduced the occurrence of POPF in patients with carcinoma of the papilla of Vater. Methods: Between 2006 and 2018, 49 patients with carcinoma of the papilla of Vater underwent PD at our institution. The m-BA has been used since 2016. We analyzed the short-term outcomes between the m-BA group (n=15) and the conventional anastomosis group (n=34). Grade B/C POPF was defined according to the 2016 ISGPS update. Results: There were no significant differences in patient characteristics including sex, age, BMI, and UICC stage between the two groups. The rate of POPF did not differ between the groups (53.3% vs 50.0%). However, postpancreatectomy hemorrhage (PPH) in the m-BA group was significantly lower than the conventional group (0% vs 23.5%, p=0.04). Grade C POPF rate was lower in the m-BA group (0% vs 8.8%) but not statistically significant. Conclusions: Although the rates of POPF were not dissimilar, the m-BA reduced the occurrence of PPH which is associated with more severe complications.