Comparison of Modified Blumgart pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy

Wang, Shin‐E; Chen, Shih‐Chin; Shyr, Bor‐Uei; Shyr, Yi‐Ming

doi:10.1016/j.hpb.2015.09.007

Cited by 65 publications

(43 citation statements)

References 24 publications

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“…We believe that both Kakita and Blumgart anastomosis are basically the same method. In addition, blood flow at the pancreatic anastomosis is important to optimize healing of the pancreatic reconstruction [ 19 ], and our results indicate that even in Blumgart anastomosis with mattress U-sutures, the rate of latent PF due to ischemia was not higher than that in Kakita anastomosis, as was reported previously [ 20 ].…”

Section: Discussionsupporting

confidence: 80%

Comparison of pancreatojejunostomy techniques in patients with a soft pancreas: Kakita anastomosis and Blumgart anastomosis

et al. 2018

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BackgroundPostoperative pancreatic fistula (PF) is the main cause of operative mortality in patients who undergo pancreatoduodenectomy. Various pancreatoenteric anastomosis techniques have been reported to minimize the postoperative PF rate. However, the optimal method remains unknown. This study was performed to clarify the impact of pancreatojejunostomy on clinically relevant PF (CR-PF) between Blumgart anastomosis and Kakita anastomosis in patients with a soft pancreas.MethodsIn total, 620 consecutive patients underwent pancreatoduodenectomy at our institute from January 2010 to December 2016, and 282 patients with a soft pancreas were analyzed (Blumgart anastomosis, n = 110; Kakita anastomosis, n = 176). Short-term outcomes were assessed, and univariate and multivariate analyses of several clinicopathological variables were performed to analyze factors affecting the incidence of CR-PF.ResultsThe CR-PF rate was 42.7% (122/286). The CR-PF rate was not significantly different between the Blumgart and Kakita groups (42.7% and 42.6%, respectively; p = 0.985). The morbidity rate (Clavien–Dindo grade ≥ IIIa) was 24.5% (70/286), and the operation-related mortality rate was 0.7% (2/286). In the multivariate analysis, male sex (p = 0.0245) and a body mass index of ≥22 kg/m2 (p < 0.0001) were statistically significant risk factors for CR-PF.ConclusionsThe CR-PF rate was not significantly different between patients treated with Kakita versus Blumgart anastomosis.

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Section: Discussionsupporting

confidence: 80%

Comparison of pancreatojejunostomy techniques in patients with a soft pancreas: Kakita anastomosis and Blumgart anastomosis

et al. 2018

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“…All procedures were performed using the same surgical technique by the same surgical team including SE Wang and YM Shyr, who both performed >500 OPD procedures at a single institution. The technique for pancreatic reconstruction involved modified Blumgart pancreaticojejunostomy (PJ), which has been previously described in detail . Briefly, Blumgart PJ was constructed using three or four transpancreatic U‐sutures with 3‐0 monofilament synthetic absorbable sutures made of polydioxanone (PDS™), with one placed cranial and one or two placed caudal to the pancreatic duct.…”

Section: Methodsmentioning

confidence: 99%

Chyle leakage after robotic and open pancreaticoduodenectomy

Shyr

Chen

et al. 2020

J Hepato Biliary Pancreat

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Background: Chyle leakage is a well-known but poorly characterized complication after pancreaticoduodenectomy (PD). No study examined the chyle leakage after robotic PD (RPD). Methods: Data regarding chyle leakage were prospectively collected and analyzed from patients undergoing RPD or open PD (OPD). Results: The study included 118 RPD and 165 OPD. Overall chyle leakage rate was 12.0%, with 13.6% for RPD and 10.9% for OPD. Chyle leakage was eventually resolved in all patients through conservative treatment. The drainage volumes were significantly higher in chyle leakage group from postoperative days (PODs) 1-7, with a median of 240 mL on POD 1 and POD 7, as compared to 160 mL on POD 1 and 70 mL on POD 7 for those without chyle leakage. The number of lymph nodes involved and resected and pancreatic head adenocarcinoma affected the risk of developing chyle leakage, whereas the surgical approach used (RPD or OPD) did not. Conclusions: Chyle leakage after PD is not rare, and it can eventually be resolved through conservative treatment. The extent and radicality of the surgery probably have a significant effect on the risk of developing chyle leakage, but the surgical approach used does not. K E Y W O R D S chyle, leakage, open, pancreaticoduodenectomy, robotic

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“…In our suturing method, 6-8 stitches are placed during pancreatic parenchyma-jejunal seromuscular anastomosis, as previously mentioned. Procedures that use fewer stitches such as the modi ed Blumgart method 4,23 should be taken into consideration for better results, as they might help in preventing pancreatic juice leakage from suturing holes.…”

Section: Discussionmentioning

confidence: 99%

“…Introduction Pancreaticoduodenectomy (PD) remains the surgery of choice for the majority of lesions involving the pancreatic head, uncus, and neck. There have been several improvements in the PD procedure and perioperative treatment approaches in recent decades 1 , including the use of somatostatin analogues 2 , pancreatic duct stenting 3 , brin glue 3 , suturing techniques that include duct-mucosa anastomosis 4 , and sophisticated prophylactic drainage measures 5 . Despite these developments, postoperative pancreatic stulas (POPFs) are commonly observed (22-26%) 6 and remain the most challenging complication following PD because they are the primary cause of mortality 7 and associated with high costs 8 .…”

Section: Read Full Licensementioning

confidence: 99%

Usefulness of the abdominal fat area-based risk score for postoperative pancreatic fistula after pancreatoduodenectomy

Endo

Kitago

Shinoda

et al. 2020

Preprint

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BackgroundPancreatic fistulas remain a significant concern after pancreatectomy, and it is not possible to perform preoperative risk stratification for all patients. This study aimed to evaluate the usefulness of a unique risk model, based on the abdominal fat area (AFA) calculated by computed tomography, for pancreatic fistula development after pancreatoduodenectomy and compare it with models based on the body mass index (BMI) or abdominal thickness.Material and Methods Patient characteristics, preoperative laboratory data, radiographic findings, and their association with pancreatic fistula development after pancreaticoduodenectomy were analysed for 158 patients who underwent resection between 2011 and 2017. Clinically relevant postoperative pancreatic fistulas (CR-POPF) were defined as Grade B or C fistulas based on the International Study Group of Pancreatic Surgery (ISGPS) 2016 consensus.ResultsCR-POPF developed in 38 patients (24.2%). Multivariate logistic analysis indicated that the AFA, BMI, and intra-abdominal thickness were potential candidates for predictive models for pancreatic fistula development, small pancreatic duct diameter, diabetes mellitus development, and the pathology of non-pancreatic cancers. When comparing the three risk models (AFA-, BMI-, and intra-abdominal thickness-based), the AFA-derived risk model was superior to the BMI-based and intra-abdominal thickness-based risk stratification models (area under the curve 0.836 vs 0.824 vs 0.826).Conclusions The risk model based on AFA calculation was superior to that based on BMI or intra-abdominal thickness measurements. The model must be validated further to elucidate the efficacy of the risk scoring system in more detail.

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Comparison of Modified Blumgart pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy

Abstract: Blumgart PJ is superior to PG in terms of pancreatic leakage and surgical mortality. Blumgart PJ can be recommended for pancreatic reconstruction after PD for all pancreatic remnant subtypes.

Cited by 65 publications

References 24 publications

Comparison of pancreatojejunostomy techniques in patients with a soft pancreas: Kakita anastomosis and Blumgart anastomosis

Comparison of pancreatojejunostomy techniques in patients with a soft pancreas: Kakita anastomosis and Blumgart anastomosis

Chyle leakage after robotic and open pancreaticoduodenectomy

Usefulness of the abdominal fat area-based risk score for postoperative pancreatic fistula after pancreatoduodenectomy

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