Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2019; 25(20): 2514-2523
Published online May 28, 2019. doi: 10.3748/wjg.v25.i20.2514
Effect of Blumgart anastomosis in reducing the incidence rate of pancreatic fistula after pancreatoduodenectomy
Ya-Tong Li, Han-Yu Zhang, Cheng Xing, Cheng Ding, Wen-Ming Wu, Quan Liao, Tai-Ping Zhang, Yu-Pei Zhao, Meng-Hua Dai
Ya-Tong Li, Han-Yu Zhang, Cheng Xing, Cheng Ding, Wen-Ming Wu, Quan Liao, Tai-Ping Zhang, Yu-Pei Zhao, Meng-Hua Dai, Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
Author contributions: Li YT and Zhang HY are co-first authors of this article; Li YT wrote the paper; Li YT, Zhang HY, Xing C, and Ding C collected and analyzed the data; Wu WM, Liao Q, Zhang TP, Zhao YP, and Dai MH operated the surgeries; Dai MH guided the study.
Institutional review board statement: The study was reviewed and approved by the Peking Union Medical College Hospital Institutional Review Board.
Informed consent statement: All the patients involved in our study gave written informed consent.
Conflict-of-interest statement: The authors disclose that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Meng-Hua Dai, MD, Doctor, Professor, Department of General Surgery, Peking Union Medical College Hospital, No. 1, Shuai Fu Yuan, Dongcheng District, Beijing 100730, China. daimh@pumch.cn
Telephone: +86-10-6915-2600 Fax: +86-10-6915-6021
Received: March 14, 2019
Peer-review started: March 14, 2019
First decision: April 4, 2019
Revised: May 2, 2019
Accepted: May 8, 2019
Article in press: May 8, 2019
Published online: May 28, 2019
Processing time: 76 Days and 16 Hours
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.

Keywords: Blumgart anastomosis; Pancreaticojejunostomy; Postoperative pancreatic fistula; Pancreatoduodenectomy; Incidence

Core tip: In this study, we made a retrospective analysis of Blumgart anastomosis and traditional embedded pancreaticojejunostomy in pancreatoduodenectomy, and confirmed the benefits of Blumgart anastomosis in the aspects of intraoperative and post-operative courses, especially in reducing the incidence rate of postoperative pancreatic fistula, as well as its non-inferiority features in the long-term statuses. Surgical method should be a key factor in reducing postoperative pancreatic fistula. It should have been added into the calculator of pancreatic fistula, and Blumgart anastomosis needs further promotion.