The vulnerable point of modified blumgart pancreaticojejunostomy regarding pancreatic fistula learned from 50 consecutive pancreaticoduodenectomy

Sung Geun Kim, Kwang Yeol Paik, Ji Seon Oh


Background: Blumgart anastomosis (BA) during pancreaticoduodenectomy (PD) had reduced postoperative pancreatic fistula (POPF) after PD in literatures. The aim of this study is to report surgical results from a consecutive series of operation using the modified BA method.
Methods: Data from 50 consecutive patients who underwent PD using modified BA between September 2011 and August 2018 were prospectively collected and retrospectively analyzed, regarding POPF, other morbidities, and mortality.
Results: Overall incidence of POPF was 10.0%, the rate of grade B POPF was 8.0% (4/50) and grade C was 2.0% (1/50). Among 50 patients, 5 post pancreatectomy hemorrhages (PPHs) (10.0%) including 2 POPF related bleeding, and 4 abscesses including 2 related to POPF occurred. Fistula risk grades were as follows: 0 negligible, 6 low, 36 intermediate, and 8 high. Except for one patient, fistulas improved over the clinical course after radiologic intervention drainage and angiography. The mortality occurred due to POPF followed by jejunal detachment from the remnant pancreas stump. In this case, jejunum was too thin, compared to the pancreatic thickness.
Conclusions: This retrospective single-center result demonstrated that the modified BA had an acceptable rate of POPF. Modified BA may be risky and potentially provoke fatal POPF, when joining a thin jejunum and thick pancreas.