Blumgart's technique of pancreaticojejunostomy: Analysis of safety and outcomes

Gupta, Vishal; Kumar, Saket; Gupta, V.; Joshi, Pradeep; Rahul, Rahul; Yadav, Rakesh Kumar; Dangi, Amit; Chandra, Abhijit

doi:10.1016/j.hbpd.2019.01.007

Cited by 11 publications

(14 citation statements)

References 38 publications

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“…The full texts of the remaining 29 records were assessed for eligibility. Of these, 18 were excluded because they were trial protocols [50][51][52][53] , review 39 , letter 54 , studies with no comparison with BA 18,[20][21][22][23][25][26][27][28][29] and studies related with BA versus pancreaticogastrostomy 55,56 . Ultimately, one RCT 30 (from Asia) and ten non-randomized comparative studies (2 from Europe 19,38 and 8 from Asia 24,[31][32][33][34][35][36][37] ) involving a total of 2412 patients were included in the quantitative syntheses.…”

Section: Resultsmentioning

confidence: 99%

“…The BA has been reported to decrease the rate of grade B/C POPF to 0.67-7.14% [20][21][22] , significantly lower than the 10-20% in other reconstruction methods. The advantage of this technique was that U suture could avoid tangential shearing force 23,24 . Previously, BA has been reported with the advantage of reducing POPF in few case series or non-comparative retrospective studies 18,[20][21][22][23][25][26][27][28][29] .…”

mentioning

confidence: 99%

“…The advantage of this technique was that U suture could avoid tangential shearing force 23,24 . Previously, BA has been reported with the advantage of reducing POPF in few case series or non-comparative retrospective studies 18,[20][21][22][23][25][26][27][28][29] . At the same time, only one RCT 30 and some retrospective comparative studies 19,24,[31][32][33][34][35][36][37][38] have been reported for comparison between BA and other PJ.…”

mentioning

confidence: 99%

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Blumgart anastomosis reduces the incidence of pancreatic fistula after pancreaticoduodenectomy: a systematic review and meta-analysis

Wei

Xia

et al. 2020

Sci Rep

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Postoperative pancreatic fistula (POPF) is the most serious complication after pancreaticoduodenectomy (PD). Recently, Blumgart anastomosis (BA) has been found to have some advantages in terms of decreasing POPF compared with other pancreaticojejunostomy (PJ) using either the duct-to-mucosa or invagination approach. Therefore, the aim of this study was to examine the safety and effectiveness of BA versus non-Blumgart anastomosis after PD. The PubMed, EMBASE, Web of Science and the Cochrane Central Library were systematically searched for studies published from January 2000 to March 2020. One RCT and ten retrospective comparative studies were included with 2412 patients, of whom 1155 (47.9%) underwent BA and 1257 (52.1%) underwent non-Blumgart anastomosis. BA was associated with significantly lower rates of grade B/C POPF (OR 0.38, 0.22 to 0.65; P = 0.004) than non-Blumgart anastomosis. Additionally, in the subgroup analysis, the grade B/C POPF was also reduced in BA group than the Kakita anastomosis group. There was no significant difference regarding grade B/C POPF in terms of soft pancreatic texture between the BA and non-Blumgart anastomosis groups. In conclusion, BA after PD was associated with a decreased risk of grade B/C POPF. Therefore, BA seems to be a valuable PJ to reduce POPF comparing with non-Blumgart anastomosis.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Blumgart anastomosis reduces the incidence of pancreatic fistula after pancreaticoduodenectomy: a systematic review and meta-analysis

Wei

Xia

et al. 2020

Sci Rep

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“…The Achilles' heel of pancreatoduodenectomy (PD) remains the pancreatico-enteric anastomosis. Pancreatico-enteric anastomotic leak manifests as the postoperative pancreatic fistula (POPF), and may be associated with high post-operative morbidity [1].…”

Section: Introductionmentioning

confidence: 99%

Validation of the Fistula Risk Score for Post-operative Pancreatic Fistula After Pancreatoduodenectomy

et al. 2020

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The fistula risk score (FRS) has been developed to predict clinically relevant postoperative pancreatic fistula (CR-POPF). This study aimed to validate its applicability in patients undergoing pancreatoduodenectomy at a tertiary care teaching centre in northern India. Historical records of 105 patients who underwent pancreatoduodenectomy between January 2010 and December 2017 were reviewed. The FRS was calculated for each patient based on operative records. Various outcome parameters, including POPF, were evaluated across four discrete risk zones. The performance of the model was assessed by area under the receiver operating curve. Based on FRS, patients were grouped into 4 risk zones: Group A (negligible risk, score 0): 4 patients (3.8%); Group B (low risk, score 1-2): 35 patients (33.3%); Group C (moderate risk, score 3-6): 54 patients (51.4%), and Group D (high risk, score 7-10): 12 patients (11.4%). Overall incidence of CR-POPF was 15.2%. The incidence of CR-POPF in negligible, low, moderate, and high-risk patients was 0%, 8.5%, 14.8%, and 41.6%, respectively (p = 0.003). Increasing FRS correlated well with the CR-POPF development on univariate (p < 0.03) and multivariate (p < 0.04) analysis. Upon assessing the model performance for fistula risk zones using area under the receiver operating curve, an overall result of 0.80 (95 CI 0.71-0.87) was obtained, indicating good ability of the FRS to predict the development of CR-POPF. This single institutional experience validates FRS as a good and reliable tool for predicting the development of CR-POPF after pancreatoduodenectomy. This study affirms its universal applicability.

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“…BA is an emerging technique of pancreaticoenteric anastomosis with low rates of CR-POPF (9). In most of RCTs regarding the method of pancreaticoenterostomy, the method used for PJ was not BA.…”

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confidence: 99%

Implication of pancreaticoenterostomy regarding postoperative pancreatic fistula

Paik

2020

Ann Transl Med

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Blumgart's technique of pancreaticojejunostomy: Analysis of safety and outcomes

Cited by 11 publications

References 38 publications

Blumgart anastomosis reduces the incidence of pancreatic fistula after pancreaticoduodenectomy: a systematic review and meta-analysis

Blumgart anastomosis reduces the incidence of pancreatic fistula after pancreaticoduodenectomy: a systematic review and meta-analysis

Validation of the Fistula Risk Score for Post-operative Pancreatic Fistula After Pancreatoduodenectomy

Implication of pancreaticoenterostomy regarding postoperative pancreatic fistula

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