The Vulnerable Point of Modified Blumgart Pancreaticojejunostomy Regarding Pancreatic Fistula Learned from 50 Consecutive Pancreaticoduodenectomy

Abstract

Introduction: The aim of this study is to report clinically relevant postoperative pancreatic fistula (CR-POPF) and other complications after pancreaticojejunostomy (PJ) after modified Blumgart anastomoses. Method: Data of consecutive 50 patients who underwent pancreaticoduodenectomy using modified Blumgart PJ between January 2010 and August 2018 were prospectively collected and retrospectively analyzed, regarding CR-POPF and other morbidity and mortality. Result: Overall incidence of POPF was 24.0%, the rate of Grade B POPF was 8.0% (4/50) and Grade C was 2.3% (1/50). Among 50 patients, five post pancreatectomy hemorrhages (10.0%) including three POPF related bleeding, and four abscesses including three POPF related with it were occurred. Fistula Risk Grades were 0 Negligible, 6 Low, 36 Intermediate, and 8 High. They were well improved the clinical courses after radiologic intervention under drainage and angiography except one. One mortality occurred because of POPF followed by jejunal blowout from the remnant pancreas stump. In case of mortality, diameter of jejunum was too short compared to the pancreas stump height. Conclusion: This retrospective single-center Result demonstrated that the modified Blumgart PJ show acceptable rate of CR POPF (10.0%). When the jejunal diameter is shorter than a pancreas stump height, modified Blumgart PJ may be risky and potentially provoke fatal POPF.