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 AND 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.