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

BACKGROUND: We 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/METHODS: Data 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. RESULTS: During 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. CONCLUSIONS: Upon 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.