Rate And Grade of Postoperative Pancreatic Fistula After Modified Blumgart Pancreaticojejunostomy in Pancreaticoduodenectomy

Abstract

Introduction: Pancreaticoduodenectomy (PD), commonly known as the Whipple procedure, is the standard surgical approach for treating pancreatic and periampullary cancers. Despite advancements in surgical techniques, postoperative pancreatic fistula (POPF) remains one of the most significant complications following PD, contributing to increased morbidity. This study aims to evaluate the development and severity of POPF in patients undergoing PD with the Modified Blumgart Pancreaticojejunostomy. Methods: This Cross-sectional Observational study was carried out among the indoor patients of surgery units in Dhaka Medical College & Hospital, Dhaka, from January 2023 to December 2023. All patients who experienced Pancreatoduodenectomy in the Surgery department of Dhaka Medical College & Hospital during the study period were considered as the study population. A total of 30 patients were selected as study subjects by purposive sampling technique. Consent from patients and relevant authorities was taken. Univariate and multivariate analysis of the data was carried out using a statistical analysis software program. Descriptive analysis of continuous variables was carried out and showed as the means ± SD. Result: This study involved 30 patients, with the majority (36.6%) aged between 40-50 years and male predominance (63.3%). Most patients (50%) were diagnosed preoperatively with periampullary carcinoma, followed by pancreatic carcinoma (40%). Postoperative pancreatic fistula occurred in 13.3% of patients, with the majority (75%) being Grade B fistulas, and 25% classified as Grade A. No Grade C fistulas were observed. Conclusion: Placing sutures between the pancreatic tissue and the jejunum carries a risk of pancreatic juice leakage due to needle holes or injury to the pancreatic tissue, particularly in patients with a soft pancreas. Therefore, this study suggests that an anastomosis technique utilizing fewer sutures may be more advantageous. The original Blumgart anastomosis employed four to six trans pancreatic/jejunal seromuscular sutures, whereas our approach utilized only one to three. Additionally, the modified Blumgart technique ensured complete coverage of the pancreatic stump with jejunal serosa through the modified lateral suture that penetrates the seromuscular layer of the jejunum