Surgical outcomes of combined modified Blumgart pancreaticojejunostomy and long internal pancreatic duct stent for pancreaticoduodenectomy

Abstract

Background: Postoperative pancreatic fistula (POPF) is the most serious complication in patients who underwent pancreaticoduodenectomy (PD). The Blumgart anastomosis and its modifications are the favorable techniques of pancreaticojejunostomy anastomosis (PJ) performed worldwide. This report proposed the surgical outcomes of combined the new technique of modified Blumgart anastomosis with the long internal pancreatic duct stent for the (PJ). Study design: We evaluated the surgical outcomes of a consecutive series of the patients at Panyananthaphikkhu Chonprathan Medical Center who underwent PD from June 2017 to June 2020. PJ was conducted in all cases using the transpancreatic mattress suture modified from the original Blumgart's technique and the long pancreatic duct stent was placed across the anastomosis. The primary endpoints were clinically relevant postoperative pancreatic fistula (CR-POPF) and 30-day mortality rate. The secondary endpoints were the early postoperative complications. Results: Twelve patients underwent PD using the proposed technique. Overall mortality was 8.3%. The rate of CR-POPF was 33.3%, two patients had a prolonged period of the intraabdominal drain, and one patient underwent the percutaneous drainage of the intraabdominal collection. The only patient with Grade C-POPF died after re-exploration due to severe septicemia. The median postoperative length of stay (LOS) was 12 days. Conclusions: The combination of the new technique of modified Blumgart PJ with the long internal pancreatic duct stent is an alternative technique that may prevent the pancreatic fistula. The CR-POPF rate and the overall survival are comparable to prior literature. However, further study is needed to clarify the definite outcomes. © 2021 The Author(s)