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01-06-2014 | Original Article

Modified Blumgart Anastomosis for Pancreaticojejunostomy: Technical Improvement in Matched Historical Control Study

Authors: Tsutomu Fujii, Hiroyuki Sugimoto, Suguru Yamada, Mitsuro Kanda, Masaya Suenaga, Hideki Takami, Masashi Hattori, Yoshikuni Inokawa, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera

Published in: Journal of Gastrointestinal Surgery | Issue 6/2014

Abstract

Background

Postoperative pancreatic fistula (POPF) is the main cause of fatal complications after pancreatoduodenectomy. There is still no universally accepted technique for pancreaticoenterostomy, especially in patients with soft pancreas.

Methods

Between July 2008 and June 2013, 240 patients who underwent pancreatoduodenectomy were enrolled in this single-institution matched historical control study. To approximate the pancreatic parenchyma to the jejunal seromuscular layer, 120 patients underwent anastomosis using the Kakita method (three or four interrupted penetrating sutures) and 120 underwent anastomosis using the modified Blumgart anastomosis (m-BA) method (one to three transpancreatic/jejunal seromuscular sutures to completely cover the pancreatic stump with jejunal serosa).

Results

The rate of clinically relevant POPF formation was significantly lower in the m-BA group than that in the Kakita group (2.5 vs 36 %; p < 0.001). The duration of drain placement and the length of postoperative hospital stay were significantly shorter in the m-BA group. Multivariate analysis showed that m-BA was an independent predictor of non-formation of POPF (hazard ratio, 0.02; 95 % confidence interval, 0.01–0.08; p < 0.001).

Conclusion

The m-BA method is safe and simple and improves postoperative outcomes. We suggest that the m-BA is suitable for use as a standard method of pancreaticojejunostomy after pancreatoduodenectomy.

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Title: Modified Blumgart Anastomosis for Pancreaticojejunostomy: Technical Improvement in Matched Historical Control Study
Authors: Tsutomu Fujii
Hiroyuki Sugimoto
Suguru Yamada
Mitsuro Kanda
Masaya Suenaga
Hideki Takami
Masashi Hattori
Yoshikuni Inokawa
Shuji Nomoto
Michitaka Fujiwara
Yasuhiro Kodera
Publication date: 01-06-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 6/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2523-3

At a glance: The STEP trials

Springer Medicine

Modified Blumgart Anastomosis for Pancreaticojejunostomy: Technical Improvement in Matched Historical Control Study

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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