Comparison of Modified Blumgart pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy

Abstract Background The aim of this study was to compare perioperative outcomes after Blumgart pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) for pancreatic-enteric reconstruction following pancreaticoduodenectomy. Methods Data of patients undergoing Blumgart PJ and PG were retrieved fr...

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Bibliographic Details
Published in:HPB (Oxford, England) England), 2016-03, Vol.18 (3), p.229-235
Main Authors: Wang, Shin-E, Chen, Shih-Chin, Shyr, Bor-Uei, Shyr, Yi-Ming
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Databases, Factual
Female
Gastroenterology and Hepatology
Gastrostomy - adverse effects
Gastrostomy - methods
Gastrostomy - mortality
Humans
Length of Stay
Male
Middle Aged
Original
Pancreatic Fistula - diagnosis
Pancreatic Fistula - etiology
Pancreaticoduodenectomy - adverse effects
Pancreaticoduodenectomy - mortality
Pancreaticojejunostomy - adverse effects
Pancreaticojejunostomy - mortality
Risk Factors
Time Factors
Treatment Outcome
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Summary:Abstract Background The aim of this study was to compare perioperative outcomes after Blumgart pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) for pancreatic-enteric reconstruction following pancreaticoduodenectomy. Methods Data of patients undergoing Blumgart PJ and PG were retrieved from prospectively-collected database. Matched patients in each surgical groups were included based on the Callery risk scoring system for clinically relevant postoperative pancreatic fistula (CR-POPF) (grades B and C). Surgical parameters and risks were compared between these two groups. Results A total of 206 patients undergoing PD were included. Blumgart PJ was associated with shorter postoperative hospital stay (median (range) 25 (10–99) vs. 27 (10–97) days, P  = 0.022). There was no surgical mortality in the Blumgart PJ group, but a 4.9% perioperative mortality in the PG, P  = 0.030. The CR-POPF by Blumgrt PG is significantly lower than that by PG for overall patients (7% vs. 20%, P  = 0.007), especially for those in intermediate fistula risk zone (6% vs. 21%, P  = 0.048) and high fistula risk zone (14% vs. 47%, P = 0.038). Conclusions 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.
ISSN:1365-182X
1477-2574
DOI:10.1016/j.hpb.2015.09.007