Modified Blumgart Anastomosis Research Articles

A comparison of pancreatojejunostomy using the modified Blumgart anastomosis with or without a four-needle three-loop suture device and continuous sutures for duct-to-mucosa anastomosis in robotic pancreaticoduodenectomy.

Despite descriptions of different pancreatojejunostomy procedures using robotic pancreaticoduodenectomy (RPD), a standardized procedure has not yet been established. No prior report has described pancreatojejunostomy by RPD combined with modified Blumgart anastomosis with continuous suturing for duct-to-mucosa anastomosis. This study investigated this surgical technique and evaluated the short-term outcomes of the simplified pancreatojejunostomy procedure. Between December 2021 and March 2024, 36 patients underwent pancreatojejunostomy using modified Blumgart anastomosis with continuous suturing for duct-to-mucosa anastomosis using RPD. Patients were divided into an early group (n = 15), without the use of the new four-needle three-loop suture device during the modified Blumgart anastomosis and a late group (n = 21) that did use this device. The late group had a significantly shorter pancreatojejunostomy duration (60min vs. 49min, p = 0.004) than the early group. Both groups showed equivalent postoperative outcomes; however, the late group exhibited a trend toward a lower rate of postoperative pancreatic fistula grade ≥ B (26.7% vs. 4.8%, p = 0.138). Pancreatojejunostomy using modified Blumgart anastomosis with a four-needle three-loop suture device and continuous suture for duct-to-mucosa anastomosis in patients undergoing RPD is simple and effective. This new suturing device may further reduce the incidence of postoperative pancreatic fistulas.

Technical details of robotic pancreatojejunostomy using a modified Blumgart anastomosis: Thread manipulation using gauze and an assisted port.

Pancreatojejunostomy is a technically demanding procedure during robotic pancreaticoduodenectomy (RPD). Modified Blumgart anastomosis (mBA) is a common method for the pancreatojejunostomy; however, the technical details for roboticmBA are not well established. During RPD, we performed a mBA for the pancreatojejunostomy using thread manipulation with gauze and an additional assist port. Patients who underwent robotic pancreatoduodenectomy at Fujita Health University from November 2009 to May 2023 were retrospectively investigated, and technical details for the robotic-modified Blumgart anastomosis were demonstrated. Among 78 patients who underwent RPD during the study period, 33 underwent robotic mBA. Postoperative pancreatic fistula (POPF) occurred in six patients (18%). None of the patients suffered POPF Grade C according to the international study group of pancreatic surgery definition. The anastomotic time for mBA was 80min (54-125min). Robotic mBA resulted in reasonable outcomes. We propose that mBA could be used as one of the standard methods for robotic pancreatojejunosotomy.

A modified Blumgart anastomosis with a simple and practicable procedure after laparoscopic pancreaticoduodenectomy: our center’s experience

BackgroundLaparoscopic pancreaticoduodenectomy(LPD) has become the goal of lots of minimally invasive surgical centers in recent years. Postoperative pancreatic fistula(POPF) is still the barrier to attaining the above goal. Thus, improving anastomosis techniques to reduce the rate of POPF has been a hotspot of surgery. Blumgart pancreaticojejunostomy is considered one of the best anastomosis procedures, with low rates of POPF. However, the original Blumgart pancreaticojejunostomy method is not easy for laparoscopic operation. In consequence, we modified a Blumgart pancreaticojejunostomy technique with a simple and practicable procedure and applied to LPD.MethodsWe collected and retrospectively analyzed the perioperative clinical data of patients who underwent modified Blumgart anastomosis from February 2017 to September 2022. The above patients included 53 cases in open pancreaticojejunostomy(OPD) and 58 cases in LPD. After propensity score matching, 44 cases were included for comparison in each group.ResultsAfter propensity score matching, the average time for pancreaticojejunostomy was about 30 min in the LPD group. The Clinically relevant POPF(CR-POPF) rate was 9.1%. The length of postoperative hospitalization was 13.1 days. Compared with the OPD group, The CR-POPF rate in the LPD group are not significant differences. But the postoperative length of hospital stay was significantly shorter in the LPD group. Besides, there were no other severely postoperative complications between two groups.ConclusionThe modified Blumgart anastomosis technique applied to LPD in our Center not only has simple and convenient properties but also low rate of CR-POPF. And this method may be a good choice for surgeons to begin to carry out LPD.

Completely 3-dimensional laparoscopic pancreaticoduodenectomy with modified Blumgart pancreaticojejunostomy: an analysis of 100 consecutive cases.

Although laparoscopic pancreaticoduodenectomy (LPD) is increasingly performed in high-volume centers, pancreaticojejunostomy (PJ) is still the most challenging procedure. Pancreatic anastomotic leakage remains a major complication after PD. Thus, various technical modifications regarding PJ, such as the Blumgart technique, have been attempted to simplify the procedure and minimize anastomotic leakage. Three-dimensional (3D) laparoscopic systems have been shown to be particularly helpful in performing difficult and precise tasks. We present a modified Blumgart anastomosis in 3D-LPD and investigate its clinical outcomes. A retrospective analysis of 100 patients who underwent 3D-LPD with modified Blumgart PJ from September 2018 to January 2020 was conducted. Data on the preoperative characteristics, operative outcomes, and postoperative characteristics of the patients were collected and analyzed. The mean operative time and duration of PJ were 348.2 and 25.1min, respectively. The mean estimated blood loss was 112mL. The overall rate of postoperative complications over Clavien‒Dindo classification III was 18%. The incidence of clinically relevant postoperative pancreatic fistula was 11%. The median postoperative hospital stay was 14.2days. Only one patient required reoperation (1%), and no patient died in the hospital or 90days after the operation. High BMI, small main pancreatic duct diameter, and soft pancreatic consistency had a significant influence on the occurrence of CR-POPF. The surgical outcome of 3D-LPD with modified Blumgart PJ seems to be comparable to other studies in terms of operation time, blood loss, hospital stay, and complication incidence. We consider the modified Blumgart technique in 3D-LPD to be novel, reliable, safe, and favorable for PJ in the PD procedure.

Teres ligamentum wrap covering the pancreaticojejunostomy following pancreatoduodenectomy is associated with a lower rate of postoperative pancreas fistula: a prospective cohort study

BackgroundPost-operative pancreas fistula (POPF) is a common complication after pancreatoduodenectomy (PD). A Teres Ligamentum (TL)-wrap covering the pancreaticojejunostomy (PJ) is suggested as a potential solution to reduce POPF. The aim of this study was to compare POPF incidence (grade B/C) in patients with or without a TL-wrap. MethodsA prospective cohort study was performed between January 2019–December 2021. All consecutive patients were included. Patient, tumor and surgical characteristics and postoperative complications were compared in both open and robot-assisted surgery. ResultsA total of 118 consecutive patients were included. The first 57 patients were treated without and the following 61 patients with a TL-wrap. There were no statistically significant differences between both groups regarding patient, pre-operative treatment and surgical characteristics. The occurrence of POPF was strongly reduced in the TL-wrap group compared to patients without a TL-wrap (3.3% vs 28.1%, P < 0.001). Also mean length of hospital stay was reduced (11.5 vs 18.8 days, P = 0.030). ConclusionThe use of a TL-wrap covering the PJ as addition to the modified Blumgart anastomosis technique is associated with a significantly reduced POPF rate and a reduced length of hospital stay. A TL-wrap is a simple addition to a PJ that may be considered to improve postoperative outcome. This association must be studied more definitively in a randomized controlled trial.

Reproduction of modified Blumgart pancreaticojejunostomy in a robotic environment: a simple clipless technique.

Although modified Blumgart anastomosis (MBA) in robotic pancreaticoduodenectomy has been accepted as a simple and safe procedure that provides non-inferior surgical outcomes compared to open MBA, the details of the standardization of robotic MBAs have never been established. In this report, we detail the technical tips to reproduce MBA in the robotic environment. From January to December in 2021, 16 patients underwent our novel robotic MBA technique, which included clipless Blumgart suture and duct-to-mucosa anastomosis. To simplify the manipulation of sutures in robotic environment, short double-armed sutures in 15cm length were created and used for Blumgart suture. Duct-to-mucosa anastomosis were done by 5-0 monofilament of 6cm length. These tips enabled clipless anastomosis and minimized the burden of the patient-side assistant. Surgical and short-term outcomes were compared between patients with robotic MBA (Robo group) and those who underwent open MBA during 2021 (32 patients, Open group). The median operation time was significantly longer in the Robo group than in the Open group (551 vs. 485.5min, P = 0.0027). Estimated blood loss was significantly lower in the Robo group than in the open group (95 vs. 355mL, P < 0.0002). The median duration of clipless MBA in the Robo group was 56 (46-68) min. The incidence of POPF (grade B or C) was not significantly different among the groups (19% vs. 22%, P = 0.71). The mean length of hospital stay was significantly shorter in the Robo group than in the Open group (18 vs. 24days, P = 0.019). Clipless MBA in a robotic environment was safely performed with acceptable short-term outcomes and can be proposed as a standard technique for robotic pancreatojejunostomy.

Association of a Modified Blumgart Anastomosis With the Incidence of Pancreatic Fistula and Operation Time After Laparoscopic Pancreatoduodenectomy: A Cohort Study.

ObjectiveTo explore the association between a modified Blumgart anastomosis technique and the operative time and surgical complications.MethodsThis is a retrospective cohort study that analyzed the data of patients who underwent laparoscopic pancreaticoduodenectomy from January 2015 to March 2021. The primary outcome was to explore the association between the modified Blumgart anastomosis technique and operative time.ResultsA total of 282 patients were enrolled. There were 177 cases of pancreatic duct-to-mucosa anastomosis in the traditional surgery group, and 105 cases of the modified three-step Blumgart anastomosis in the modified group. There were no statistically significant differences in the general and intraoperative characteristics found between the two groups (P > 0.05). The surgical method was an independent predictor of operative time. Overall complications postsurgery were less common in the modified group than in the traditional group. The incidence of postoperative pancreatic fistula was higher in the traditional group than in the modified group (45 cases (25.4%) and 11 cases (10.5%), respectively). Fourteen cases (7.9%) in the traditional group and four case (3.8%) in the modified group had postoperative pancreatic fistula of grades B + C. The two groups had statistically significant differences (P < 0.05). The results of the linear regression showed that the type of surgical method was associated with operation time (95% CI, −73.074 to −23.941, β: −0.438, P < 0.001).ConclusionThis modified three-step Blumgart pancreaticojejunostomy was associated with the operation time.

Effect of Modified Blumgart Anastomosis on Surgical Outcomes After Pancreaticoduodenectomy.

Surgeons continue to be concerned about complications after pancreaticoduodenectomy, especially postoperative pancreatic fistula. Among the factors that cause postoperative pancreatic fistula, the pancreaticojejunostomy technique has stood out in recent studies. In this study, we aimed to compare the surgical outcomes, especially POPF, of the modified Blumgart and the traditional anastomosis techniques in patients who underwent pancreaticoduodenectomy. A total of 144 patients who underwent pancreaticoduodenectomy were divided into 2 groups according to the performed pancreaticojejunostomy technique (modified Blumgart anastomosis, n = 91 and traditional anastomosis, n = 53). Preoperative clinicodemographic data, perioperative findings, and postoperative results were compared between the groups. Additionally, factors associated with clinically relevant postoperative pancreatic fistula were analyzed. The modified Blumgart anastomosis group had lower clinically relevant postoperative pancreatic fistula rate than traditional anastomosis group (n = 8 (8.8%) versus n = 14 (26.4%), P = .005). On the contrary, the biochemical leakage rate was higher in the modified Blumgart anastomosis group (n = 30 (33%) versus n = 9 (17%), P = .037). While postoperative pancreatic fistula-related reoperation rate was lower (n = 2 (2.2%) versus n = 7 (13.2%), P = .013), the length of hospital stay was also shorter (11 days (5-47 days) versus 21 days (6-46 days), P < .001) in the modified Blumgart anastomosis group. Univariate and multivariate analyses revealed that modified Blumgart anastomosis was an independent and negative predictive factor for clinically relevant postoperative pancreatic fistula (odds ratio = 0.274, 95% confidence interval = 0.103-0.728, P = .009). Compared to the traditional anastomosis, modified Blumgart anastomosis decreases the rate of transition from biochemical leakage to clinically relevant postoperative pancreatic fistula and postoperative pancreatic fistula-related reoperation and also shortens the length of hospital stay. In addition, modified Blumgart anastomosis is an independent and negative predictive factor for the development of clinically relevant postoperative pancreatic fistula.

The Modified Blumgart Anastomosis for Pancreaticojejunostomy Reduces the Occurrence of Post-Operative Hemorrhage and Sever Postoperative Pancreatic Fistula: A Case Control Study

Introduction: The modified Blumgart anastomosis (m-BA) for pancreaticojejunostomy is assumed to decrease the rate of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) and has been widely introduced to clinical practice. The aim of this study was to evaluate whether the m-BA method improved the short-term outcomes of pancreaticojejunostomy in patients who underwent PD.

Laparoscopic Modified Blumgart Anastomosis with a Newly Manufactured and Customized Double Needle Suture

Laparoscopic Modified Blumgart Anastomosis with a Newly Manufactured and Customized Double Needle Suture

Surgical outcomes of combined modified Blumgart pancreaticojejunostomy and long internal pancreatic duct stent for pancreaticoduodenectomy

BackgroundPostoperative pancreatic fistula (POPF) is the most serious complication in patients who underwent pancreaticoduodenectomy (PD). The Blumgart anastomosis and its modifications are the favorable techniques of pancreaticojejunostomy anastomosis (PJ) performed worldwide. This report proposed the surgical outcomes of combined the new technique of modified Blumgart anastomosis with the long internal pancreatic duct stent for the (PJ). Study designWe evaluated the surgical outcomes of a consecutive series of the patients at Panyananthaphikkhu Chonprathan Medical Center who underwent PD from June 2017 to June 2020. PJ was conducted in all cases using the transpancreatic mattress suture modified from the original Blumgart's technique and the long pancreatic duct stent was placed across the anastomosis. The primary endpoints were clinically relevant postoperative pancreatic fistula (CR-POPF) and 30-day mortality rate. The secondary endpoints were the early postoperative complications. ResultsTwelve patients underwent PD using the proposed technique. Overall mortality was 8.3%. The rate of CR-POPF was 33.3%, two patients had a prolonged period of the intraabdominal drain, and one patient underwent the percutaneous drainage of the intraabdominal collection. The only patient with Grade C-POPF died after re-exploration due to severe septicemia. The median postoperative length of stay (LOS) was 12 days. ConclusionsThe combination of the new technique of modified Blumgart PJ with the long internal pancreatic duct stent is an alternative technique that may prevent the pancreatic fistula. The CR-POPF rate and the overall survival are comparable to prior literature. However, further study is needed to clarify the definite outcomes.

Elevated Serum Amylase Does Not Predict Pancreatic Fistula after Duodenopancreatectomy with Modified Blumgart Anastomosis and Selectively Used External Pancreatic Stent

Elevated Serum Amylase Does Not Predict Pancreatic Fistula after Duodenopancreatectomy with Modified Blumgart Anastomosis and Selectively Used External Pancreatic Stent

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

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.

The modified Blumgart anastomosis after pancreaticoduodenectomy: a retrospective single center cohort study.

ObjectivesThe postoperative pancreatic fistula (POPF) is a major complication after pancreatic head resection whereby the technique of the anastomosis is a very influencing factor. The literature describes a possible protective role of the Blumgart anastomosis.MethodsPatients after pancreatic head resection with reconstruction through the modified Blumgart anastomosis (a 2 row pancreatic anastomosis through mattress sutures of the parenchyma and duct to mucosa pancreaticojejunostomy, Blumgart-group) were compared with patients after pancreatic head resection and reconstruction through the conventional pancreatojejunostomy (single suture technique of capsule and parenchyma to seromuscularis, PJ-group). The Data were collected retrospectively. Depending on the propensity score matching in a ratio of 1:2 comparison groups were set up. Blumgart-group (n=29) and PJ-group (n=56). The primary end point was the rate of POPF. Secondary goals were duration of operation, length of hospital stay, length of stay on intermediate care units and hospital mortality.ResultsThe rate of POPF (biochemical leak, POPF “grade B” and POPF “grade C”) was less in the Blumgart-group, but without statistical relevance (p=0.23). Significantly less was the rate of POPF “grade C” in the Blumgart-group (p=0.03). Regarding the duration of hospital stay, length of stay on intermediate care units and hospital mortality, there was no relevant statistical difference between the groups (p=0.1; p=0.4; p=0.7). The duration of the operation was significantly less in the Blumgart-group (p=0.001).ConclusionsThe modified Blumgart anastomosis technique may have the potential to decrease major postoperative pancreatic fistula.

Novel Technique for Single-Layer Pancreatojejunostomy is Not Inferior to Modified Blumgart Anastomosis in Robotic Pancreatoduodenectomy: Results of a Randomized Controlled Trial

A novel technique of single-layer continuous suturing (SCS) for pancreaticojejunostomy (PJ) during robotic pancreaticoduodenectomy (RPD), a technically straightforward procedure, has been shown to produce promising results in a previous study. The present RCT aims to show that SCS during RPD does not increase the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) when compared with modified Blumgart anastomosis (MBA). Between January 2019 and September 2019, consecutive patients (ASA score ≤ 2) who underwent RPD were enrolled and randomized to the SCS or the MBA group. The primary endpoint was the rate of CR-POPF. A noninferiority margin of 10% was chosen. Of the 186 patients, 4 were excluded because PJ was not performed. The remaining 182 patients were randomized to the SCS group (n = 89) or MBA group (n = 93). CR-POPF rate was not inferior in the SCS group [SCS: 6.7%, MBA: 11.8%; 95% confidence interval (- 0.76, - 0.06), P = 0.0002]. PJ duration was significantly lower in the SCS group (P < 0.01). No significant differences were found between the two groups in operative time, estimated blood loss, postoperative hospital stay, or rates of conversion to laparotomy, morbidity, reoperation, or mortality. On subgroup analysis of patients with a soft pancreas and small main pancreatic duct, SCS significantly reduced the duration of PJ. This study showed that SCS was not inferior to MBA in terms of the CR-POPF rate during RPD. Registration number: ChiCTR1800020086 ( www.Chictr.org.cn ).

ASO Author Reflections: A Novel Technique for Single Layer Pancreatojejunostomy is not Inferior to Modified Blumgart Anastomosis in Robotic Pancreatoduodenectomy-Results of a Randomized, Controlled Trial.

ASO Author Reflections: A Novel Technique for Single Layer Pancreatojejunostomy is not Inferior to Modified Blumgart Anastomosis in Robotic Pancreatoduodenectomy-Results of a Randomized, Controlled Trial.

Modified Pancreatojejunostomy in Pancreaticoduodenectomy for the Treatment of Periampullary Tumor: 8 Years of Surgical Experience.

BackgroundWe modified the anastomosis surgical method based on the Blumgart anastomosis in pancreaticoduodenectomy. This study aimed to compare patient outcomes with regards to clinically relevant postoperative pancreatic fistula (CR-POPF) and other postoperative complications among patients receiving traditional anastomosis, classical Blumgart anastomosis, and our modified-Blumgart anastomosis.Material/MethodsData were reviewed from 229 consecutive patients with periampullary tumors who underwent pancreaticoduodenectomy administered by a single surgeon at the Tianjin Medical University Cancer Institute and Hospital between January 2010 and December 2017. Subsequently, clinical factors potentially associated with CR-POPF were analyzed.ResultsDuring the study period, the incidence of overall CR-POPF was 31 out of 229 patients (13.5%). Using Blumgart anastomosis (BA), the incidence of CR-POPF was lower at 15 out of 148 patients (10.1%), significantly lower than that of traditional anastomosis (invagination technique or “duct-to-mucosa” anastomosis) (15 out of 148 patients versus 16 out of 81 patients, P=0.042). Compared with classical Blumgart anastomosis (c-B), our modified-Blumgart anastomosis (m-BA) method had similar outcomes in terms of CR-POPF (9 out of 73 patients versus 6 out of 75 patients, P=0.383), CR-POPF-related intra-abdominal hemorrhage rate (0 out of 73 patients versus 1 out of 75 patients, P=0.322), and median length of postoperative hospital stay (19 days versus 19 days, P=0.752). There were no fatalities as a result of CR-POPF in the BA group.ConclusionsUpon review of a single surgeon’s experience over 8 years, Blumgart anastomosis might be more effective in the prevention of CR-POPF than traditional anastomosis. Our modified-Blumgart anastomosis method maintained a low rate of morbidity and mortality but with simplified procedures that can be easily put into practice. This technique can be used widely with excellent safety for pancreatojejunostomy as a part of pancreaticoduodenectomy.

Fistula risk-based use of external pancreatic drainage and modified Blumgart anastomosis minimize the postoperative fistula risk in high-risk patients

Background: Fistula risk scores are barely used for decision-making and are not validated for different surgical techniques. We studied the use of modified Blumgart anastomosis associated to a selective external pancreatic duct drainage in high-risk duodenopancreatectomy patients. Methods: 64 consecutive patients from a prospectively maintained database were included and distributed into 3 groups according to the risk score developed by Callery et al. and the selective use of external pancreatic drainage as follows: Group 1: Negligible/low risk + anastomotic stent (n=32), Group 2: Intermediate/high risk + anastomotic stent (n=19) and Group 3: Intermediate/high risk + external pancreatic drain (n=13). Results: The applied risk score kept its fistula predictive value for patients with modified Blumgart anastomosis (p<0,001). There were significantly less clinically relevant fistulas (7,7% vs 47,7%, p<0,001) in Group 3 compared to Group 2, and these were less severe according to the Clavien-Dindo complication scale. Among the intermediate/high-risk patients, Group 3 had shorter median postoperative length of stay (14 vs 19 days) and lower clinically relevant complication rate than Group 2 (15,4% vs 47,4%). Conclusion: Selective external pancreatic drainage in intermediate/high-risk patients associated to a modified Blumgart anastomosis mitigates the fistula risk after duodenopancreatectomy. Fistula risk scores should be used for decision-making purposes in the perioperative period.

Fistula risk-based use of external pancreatic drainage and modified Blumgart anastomosis minimize the postoperative fistula risk in high-risk patients

Background: Fistula risk scores are barely used for decision-making and are not validated for different surgical techniques. We studied the use of modified Blumgart anastomosis associated to a selective external pancreatic duct drainage in high-risk duodenopancreatectomy patients. Methods: 64 consecutive patients from a prospectively maintained database were included and distributed into 3 groups according to the risk score developed by Callery et al. and the selective use of external pancreatic drainage as follows: Group 1: Negligible/low risk + anastomotic stent (n=32), Group 2: Intermediate/high risk + anastomotic stent (n=19) and Group 3: Intermediate/high risk + external pancreatic drain (n=13). Results: The applied risk score kept its fistula predictive value for patients with modified Blumgart anastomosis (p<0,001). There were significantly less clinically relevant fistulas (7,7% vs 47,7%, p<0,001) in Group 3 compared to Group 2, and these were less severe according to the Clavien-Dindo complication scale. Among the intermediate/high-risk patients, Group 3 had shorter median postoperative length of stay (14 vs 19 days) and lower clinically relevant complication rate than Group 2 (15,4% vs 47,4%). Conclusion: Selective external pancreatic drainage in intermediate/high-risk patients associated to a modified Blumgart anastomosis mitigates the fistula risk after duodenopancreatectomy. Fistula risk scores should be used for decision-making purposes in the perioperative period.

Does modified Blumgart anastomosis without intra-pancreatic ductal stenting reduce post-operative pancreatic fistula after pancreaticojejunostomy?

Post-operative pancreatic fistula (POPF) is one of the most common and serious complications after pancreaticoduodenectomy (PD). The aim of this study is to retrospectively compare clinically relevant (CR) POPF and other complications after pacreaticojejunostomy (PJ) after modified Kakita (m-Kakita) or modified Blumgart (m-Blumgart) anastomoses without stenting in a single institution. One hundred twenty-eight patients underwent PJ using m-Kakita anastomoses (two interrupted penetrating sutures) between January 2009 and December 2011. One hundred eighteen patients underwent m-Blumgart anastomoses (two transpancreatic/jejunal seromuscular sutures to cover the pancreatic stump with jejunal serosa) between January 2014 and December 2015. Demographics, clinical characteristics, and post-operative mortality and morbidity were retrospectively compared between the two groups. There were no significant differences in demographics or clinical characteristics between the two groups except operative time. A significantly lower rate of CR-POPF was found in the m-Blumgart group relative to the m-Kakita group (10% vs. 19%, p=0.038). Univariate and multivariate analyses revealed that the m-Blumgart anastomosis and fistula risk category (Negligible, Low) were independently protective against CR-POPF (p<0.05). This retrospective single-center study demonstrated that the modified Blumgart method without pancreatic duct stenting was associated with a lower rate of CR-POPF.