Ann Surg Treat Res.  2022 Dec;103(6):331-339. 10.4174/astr.2022.103.6.331.

Comparisons of short-term outcomes of anastomotic methods of duct-to-mucosa pancreaticojejunostomy: out-layer continuous suture versus modified Blumgart method

• Kang YH
• Kang JS
• Lee M
• Jung HS
• Yun WG
• Cho YJ
• Han Y
• Kwon W
• Jang JY

• KMID: 2536909
• DOI: http://doi.org/10.4174/astr.2022.103.6.331

Abstract

Purpose
Postoperative pancreatic fistula (POPF) is the most troublesome complication after pancreaticojejunostomy (PJ). This study aimed to compare the short-term outcomes of 2 different methods of duct-to-mucosa PJ; out-layer continuous suture anastomosis (OCA) and the modified Blumgart method (mBM).
Methods
This retrospective cohort study enrolled patients who underwent curative-intent, open PD between 2015 and 2020. In mBM, 2 transpancreatic U-sutures were performed between the pancreatic margin and jejunum, with reinforced sutures in the central region. Patient demographics, diagnosis, intraoperative factors, postoperative complications, and POPF defined by the International Study Group on Pancreatic Fistula were investigated. Clinically relevant POPF (CR-POPF) included grades B and C POPF.
Results
A total of 184 patients underwent OCA, and 96 patients underwent mBM. The mBM group had more patients who underwent neoadjuvant therapy. The fistula risk scores were comparable between the 2 groups. Both groups showed no significant differences in CR-POPF and overall surgical complication rates. The total operation time was comparable, although the operation time for PJ was shorter in mBM.
Conclusion
No significant differences were observed in the postoperative outcomes between each group; the operation time for PJ in mBM was shorter. Therefore, mBM may be considered for utilization in duct-to-mucosa PJ.

Keyword

Pancreaticoduodenectomy; Pancreaticojejunostomy; Surgical anastomosis

Figure

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  Fig. 1 The 2 types of anastomosing technique for pancreaticojejunostomy. (A) Out-layer continuous anastomosis. (B) Modified Blumgart method.

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