Modified Blumgart anastomosis without pancreatic duct jejunum anastomosis for pancreaticduodenectomy: a feadible and safe novel technical

Abstract

Introduction: Pancreaticogastrostomy (PG) has gained popularity in recent years as a result of a possible reduction in the incidence of post-operative pancreatic fistula (POPF). Aim of the study is to evaluate double purse-string telescoped PG as a safe technique which avoids anastomotic leakage after a pancreaticoduodenectomy (PD). Methods: Data on 153 consecutive PD from 07/2010 to 07/ 2015 were prospectively collected. From 03/2014 a double purse-string telescoped PG was systematically performed. 35 patients undergoing PG were matched at a ratio of 1:1 with 35 pancreaticojejunostomy (PJ). POPF was defined according to International Study Group on Pancreatic Fistula. Results: Multivariate analysis on whole series identified soft pancreatic texture [OR 6.207 (CI 95% 2.536e15.194), p < 0.001], pancreatic duct 3 mm [OR 2.520 (CI 95% 1.053e6.032), p = 0.038] and obesity [OR 4.170 (CI 95% 1.221e14.234), p = 0.023] as independent predictors of POPF. These parameters were used as matching criteria. Demographic characteristics were similar among groups. 83% of patients presented soft pancreas and in 51%pancreatic duct was not dilated. Mortality was nil in both groups. Major morbidity was higher in PJ (34.3 vs 14.3%,p = 0.05). Overall POPF were 68.6% in PJ vs 34.3% in PG (p = 0.004). POPF grade B were 28.6% PJ vs 5.7% PG (p = 0.023). There were no grade C POPF in PG vs 7 (20%) in PJ (p = 0.011). Percutaneous drainage of abdominal collection was required in 7 PJ vs 0 PG (p = 0.011). No differences were observed in delayed gastric empting, hemorrhagic complications and biliary fistula rates. Multivariate analysis of predictors of major morbidity showed PG was an independent protective factor [OR 0.209 (CI 95% 0.053e0.826), p = 0.026]. Conclusions: PG with double-purse string telescoped PG reduce POPF compared with PJ decreasing the risk of major morbidity.