Towards universal no pancreaticojejunostomy leak

Abstract

Introduction: In a quest to decrease the incidence of pancreatic fistula after a pancreaticojejunostomy (PJ) for Whipple procedure, we used a modification of the Blumgart technique (seromuscular transpancreatic U stitch PJ) in which the U sutures were extended along the superior and inferior edges of the pancreas to completely invaginate the PJ. This was compared with 2 other conventional methods. Method: Patients who had a Whipple procedure between 2010 and 2018 in were included and divided into three groups. Group 1: (19 patients, 2010-2013) either invagination or duct to mucosa; Group 2 ( 26 patients, 2014-2015) Blumgart technique; and Group 3 (30 patients) 2016-2017, modified Blumgart Result: 3 surgeons, who work as a team, did the operations. The results were not influenced by surgeon identity. There were 75 patients, divided into 3 groups. Group I: 19 patients of whom 5 (26%) had pancreatic leaks. Group 2: 26 patients 1 (4%) leak. Group 3: 30 patients, no leaks. Thus the Blumgart technique resulted in fewer leaks compared with older techniques (P= 0.003 group 1 vs. 2 and 3). The improvement was even more pronounced in those with the modified PJ (P=0.005 groups 1 vs.3; P= 0.07 groups 1 vs. 2). Conclusion: The Blumgart technique reduced the PJ leak rate compared with older methods, and extending the U sutures along the superior and inferior borders of the pancreas was even better.