Effect of Blumgart anastomosis in reducing the incidence rate of pancreatic fistula after pancreatoduodenectomy

Abstract

BACKGROUND Pancreatic fistula is one of the most serious complications after pancreatoduodenectomy for treating any lesions at the pancreatic head. For years, surgeons have tried various methods to reduce its incidence. AIM To investigate and emphasize the clinical outcomes of Blumgart anastomosis compared with traditional anastomosis in reducing postoperative pancreatic fistula. METHODS In this observational study, a retrospective analysis of 291 patients who underwent pancreatoduodenectomy, including Blumgart anastomosis (201 patients) and traditional embedded pancreaticojejunostomy (90 patients), was performed in our hospital. The preoperative and perioperative courses and long-term follow-up status were analyzed to compare the advantages and disadvantages of the two methods. Moreover, 291 patients were then separated by the severity of postoperative pancreatic fistula, and two methods of pancreaticojejunostomy were compared to detect the features of different anastomosis. Six experienced surgeons were involved and all of them were proficient in both surgical techniques. RESULTS The characteristics of the patients in the two groups showed no significant differences, nor the preoperative information and pathological diagnoses. The operative time was significantly shorter in the Blumgart group (343.5 ± 23.0 vs 450.0 ± 40.1 min, P = 0.028), as well as the duration of pancreaticojejunostomy drainage tube placement and postoperative hospital stay (12.7 ± 0.9 d vs 17.4 ± 1.8 d, P = 0.031; and 21.9 ± 1.3 d vs 28.9 ± 1.3 d, P = 0.020, respectively). The overall complications after surgery were much less in the Blumgart group than in the embedded group (11.9% vs 26.7%, P = 0.002). Patients who underwent Blumgart anastomosis would suffer less from severe pancreatic fistula (71.9% vs 50.0%, P = 0.006), and this pancreaticojejunostomy procedure did not have worse influences on long-term complications and life quality. Thus, Blumgart anastomosis is a feasible pancreaticojejunostomy procedure in pancreatoduodenectomy surgery. It is safe in causing less postoperative complications, especially pancreatic fistula, and thus shortens the hospitalization duration. CONCLUSION Surgical method should be a key factor in reducing pancreatic fistula, and Blumgart anastomosis needs further promotion.

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

“…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. The process by which comparative studies were selected for inclusion in the present meta-analysis is shown in Fig.…”

“…The sample sizes ranged from 87 to 374 patients in individual studies. Four studies focused on the rate of POPF in soft pancreatic texture 30,[32][33][34] and eight reported the use of pancreatic duct stents, either internal or external 24,[30][31][32][33][34][35][36] . Octreotide was used in five studies selectively 19,24,30,37,38 .…”

“…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. Among some comparative studies 19,31,32,[34][35][36][37][38] , POPF was reported to be lower in the BA group; however, other studies 24,30,33 found no difference between the two methods.…”

“…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. Among some comparative studies 19,31,32,[34][35][36][37][38] , POPF was reported to be lower in the BA group; however, other studies 24,30,33 found no difference between the two methods. Previously, a review 39 was published that only described a comparison between BA and KA.…”

Pancreatic fistula after pancreatoduodenectomy due to compression of the superior mesenteric vessels: a case report

“…However, some non-randomized, retrospective studies have recently reported the safety and feasibility of Blumgart anastomosis, a pancreaticojejunostomy method, showing its low postoperative mortality rate (1-3%), reoperation rate (5-7%), and acceptable POPF rate (15-20%). Furthermore, these studies have shown that Blumgart anastomosis is more effective with respect to other pancreatic anastomoses, minimizing severe complications [23][24][25][26]. However, all these studies were retrospective, their impact on the clinical evidence was poor, and they require confirmation by a randomized controlled trial.…”