A novel modified Blumgart anastomosis for minimizing postoperative pancreatic fistula in Whipple procedure
Ye SWu JYan SShen YZhang MYu JXu XZheng SSWang WL
摘要：Backgroud Postoperative pancreatic fistula（PPF）is a lethal complication of Whipple procedure which hinging around the pancreaticojejunostomy（PJ）anastomosis.The purpose of the study was to attempt to describe a novel PJ anastomosis modified from the Blumgart anastomosis and evaluate the effect in minimizing the PPF of Whipple procedure.Method Between May 2012 to April 2015,112 consecutive patients with periampullary and pancreatic tumors who underwent standard PD in Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital,Zhejiang University School of Medicine were entered into a retrospective database. These patients were divided into modified Blumgart anastomosis（mBA） group（n=53） and invagination anastomosis（IA） group（n=59）. Statistical analysis was performed to compare the clinical features, the difference of PPF, other complications and mortality of the two group.Result The median operative duration and bleeding were 483.2 ± 152.1 min and 509.7 ± 344.7 ml, and with no significant differences between the two groups. The ratio of overall complications was no significant difference between two groups（30.2% versus 32.2%, P=0.818）. clinically relevant PPF which including grade B or C being significantly less frequent in the mBA cohort（1.9% vs 11.9%, P=0.041）. The ICU duration of mBA and IA groups were 0.3 ± 1.0 days and 0.9 ± 1.4 days（P=0.005）. And the postoperative stay of mBA and IA groups were 18.0 ± 7.0 days and 23.6 ± 16.3 days respectively（P=0.018）. Multivariate analysis showed hard texture of the pancreatic and mBA anastomosis were the protective factors of clinically relevant PPF.Conclusion The novel modified Blumgart anastomosis which firstly described in this study is an innovative, convenient, useable and security method for usage in pancreaticoduodenectomy and deserving of further research.