Ann Hepatobiliary Pancreat Surg.  2018 Aug;22(3):253-260. 10.14701/ahbps.2018.22.3.253.

Comparison of Blumgart versus conventional duct-to-mucosa anastomosis for pancreaticojejunostomy after pancreaticoduodenectomy

• Lee YN
• Kim WY

• KMID: 2420614
• DOI: http://doi.org/10.14701/ahbps.2018.22.3.253

Abstract

BACKGROUNDS/AIMS
Pancreatic leakage is a major cause of postoperative death and morbidity after pancreaticoduodenectomy (PD). A recent study introduced Blumgart anastomosis (BA), which minimizes severe complications after PD. This study compares BA with conventional anastomosis (CA) for pancreaticojejunostomy (PJ) after PD at a single institution.
METHODS
A total of 87 patients who underwent PD at our hospital between January 2003 and October 2015 were enrolled in this study. The patients were divided into two groups according to the anastomosis type. Of them, 44 patients underwent anastomosis using CA (group A, conventional duct-to-mucosa anastomosis) and 43 underwent anastomosis using BA (group B, Blumgart anastomosis).
RESULTS
There was a significant difference in duration of the operation between groups A and B (473.1±102.0 versus 386.4±58.5 min, p < 0.001) and intraoperative transfusion (2.2±2.7 versus 0.7±1.5 units, p < 0.001). There was no significant difference between groups A and B in incidence of postoperative pancreatic fistula (POPF) (43.2% versus 27.9%, p=0.137) ,postoperative hemorrhage (PPH) (13.7% versus 7.0%, p=0.209), delayed gastric emptying (DGE) (29.5% versus 9.3%, p=0.063), surgical and non-surgical complications (60.5% versus 59.1%, p=0.896), length of ICU stay (9.0±6.3 versus 7.4±7.2 days, p=0.099), or length of postoperative hospital stay (37.7±16.7 versus 41.6±15.1 days, p=0.118).
CONCLUSIONS
The results of this study suggest that BA-type PJ is not inferior to CA-type PJ in terms of postoperative complications.

Keyword

Pancreaticoduodenectomy; Pancreaticojejunostomy; Complication

MeSH Terms

Gastric Emptying
Humans
Incidence
Length of Stay
Pancreatic Fistula
Pancreaticoduodenectomy*
Pancreaticojejunostomy*
Postoperative Complications
Postoperative Hemorrhage

Figure

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  Fig. 1 Conventional duct-to-mucosa anastomosis.

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  Fig. 2 Blumgart anastomosis.

Reference

1. Batignani G, Fratini G, Zuckermann M, Bianchini E, Tonelli F. Comparison of Wirsung-jejunal duct-to-mucosa and dunking technique for pancreatojejunostomy after pancreatoduodenectomy. Hepatobiliary Pancreat Dis Int. 2005; 4:450–455. PMID: 16109535.

2. Berger AC, Howard TJ, Kennedy EP, Sauter PK, Bower-Cherry M, Dutkevitch S, et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg. 2009; 208:738–747. discussion 747-749. PMID: 19476827.

3. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138:8–13. PMID: 16003309.

4. Schoellhammer HF, Fong Y, Gagandeep S. Techniques for prevention of pancreatic leak after pancreatectomy. Hepatobiliary Surg Nutr. 2014; 3:276–287. PMID: 25392839.

5. Kleespies A, Rentsch M, Seeliger H, Albertsmeier M, Jauch KW, Bruns CJ. Blumgart anastomosis for pancreaticojejunostomy minimizes severe complications after pancreatic head resection. Br J Surg. 2009; 96:741–750. PMID: 19526614.

6. Grobmyer SR, Kooby D, Blumgart LH, Hochwald SN. Novel pancreaticojejunostomy with a low rate of anastomotic failure-related complications. J Am Coll Surg. 2010; 210:54–59. PMID: 20123332.

7. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007; 142:20–25. PMID: 17629996.

8. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007; 142:761–768. PMID: 17981197.

9. Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, et al. Reconstruction by Pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg. 2005; 242:767–771. PMID: 16327486.

10. Topal B, Fieuws S, Aerts R, Weerts J, Feryn T, Roeyen G, et al. Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullarytumours: a multicentre randomized trial. Lancet Oncol. 2013; 14:655–662. PMID: 23643139.

11. Z’graggen K, Uhl W, Friess H, Büchler MW. How to do a safe pancreatic anastomosis. J Hepatobiliary Pancreat Surg. 2002; 9:733–737. PMID: 12658408.

12. Langrehr JM, Bahra M, Jacob D, Glanemann M, Neuhaus P. Prospective randomized comparison between a new mattress technique and cattell (duct-to-mucosa) pancreaticojejunostomy for pancreatic resection. World J Surg. 2005; 29:1111–1119. discussion 1120-1121. PMID: 16091984.

13. Peng SY, Wang JW, Lau WY, Cai XJ, Mou YP, Liu YB, et al. Conventional versus binding pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg. 2007; 245:692–698. PMID: 17457161.

14. Maggiori L, Sauvanet A, Nagarajan G, Dokmak S, Aussilhou B, Belghiti J. Binding versus conventional pancreaticojejunostomy: after pancreaticoduodenectomy: a case-matched study. J Gastrointest Surg. 2010; 14:1395–1400. PMID: 20577828.

15. Fujii T, Sugimoto H, Yamada S, Kanda M, Suenaga M, Takami H, et al. Modified blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg. 2014; 18:1108–1115. PMID: 24733259.

16. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017; 161:584–591. PMID: 28040257.