Department of Gastrointestinal Surgery, Ondokuz Mayıs University School of Medicine, Samsun, Turkey.
Turk J Gastroenterol. 2022 Feb;33(2):119-126. doi: 10.5152/tjg.2021.21701.
Surgeons continue to be concerned about complications after pancreaticoduodenectomy, especially postoperative pancreatic fistula. Among the factors that cause postoperative pancreatic fistula, the pancreaticojejunostomy technique has stood out in recent studies. In this study, we aimed to compare the surgical outcomes, especially POPF, of the modified Blumgart and the traditional anastomosis techniques in patients who underwent pancreaticoduodenectomy.
A total of 144 patients who underwent pancreaticoduodenectomy were divided into 2 groups according to the performed pancreaticojejunostomy technique (modified Blumgart anastomosis, n = 91 and traditional anastomosis, n = 53). Preoperative clinicodemographic data, perioperative findings, and postoperative results were compared between the groups. Additionally, factors associated with clinically relevant postoperative pancreatic fistula were analyzed.
The modified Blumgart anastomosis group had lower clinically relevant postoperative pancreatic fistula rate than traditional anastomosis group (n = 8 (8.8%) versus n = 14 (26.4%), P = .005). On the contrary, the biochemical leakage rate was higher in the modified Blumgart anastomosis group (n = 30 (33%) versus n = 9 (17%), P = .037). While postoperative pancreatic fistula-related reoperation rate was lower (n = 2 (2.2%) versus n = 7 (13.2%), P = .013), the length of hospital stay was also shorter (11 days (5-47 days) versus 21 days (6-46 days), P < .001) in the modified Blumgart anastomosis group. Univariate and multivariate analyses revealed that modified Blumgart anastomosis was an independent and negative predictive factor for clinically relevant postoperative pancreatic fistula (odds ratio = 0.274, 95% confidence interval = 0.103-0.728, P = .009).
Compared to the traditional anastomosis, modified Blumgart anastomosis decreases the rate of transition from biochemical leakage to clinically relevant postoperative pancreatic fistula and postoperative pancreatic fistula-related reoperation and also shortens the length of hospital stay. In addition, modified Blumgart anastomosis is an independent and negative predictive factor for the development of clinically relevant postoperative pancreatic fistula.
外科医生仍然关注胰十二指肠切除术后的并发症，特别是术后胰瘘。在引起术后胰瘘的诸多因素中，胰肠吻合技术在最近的研究中尤为突出。本研究旨在比较改良的 Blumgart 法和传统吻合技术在胰十二指肠切除术后的手术结果，特别是胰瘘。
根据胰肠吻合技术（改良 Blumgart 吻合术 91 例，传统吻合术 53 例）将 144 例行胰十二指肠切除术的患者分为两组。比较两组患者的术前临床资料、围手术期发现和术后结果。此外，还分析了与临床相关的术后胰瘘相关的因素。
改良 Blumgart 吻合组的临床相关术后胰瘘发生率低于传统吻合组（n=8（8.8%）比 n=14（26.4%），P=0.005）。相反，改良 Blumgart 吻合组的生化漏出率较高（n=30（33%）比 n=9（17%），P=0.037）。术后胰瘘相关再手术率较低（n=2（2.2%）比 n=7（13.2%），P=0.013），改良 Blumgart 吻合组的住院时间也较短（11 天（5-47 天）比 21 天（6-46 天），P<0.001）。单因素和多因素分析显示，改良 Blumgart 吻合术是临床相关术后胰瘘的独立且阴性预测因素（比值比=0.274，95%置信区间=0.103-0.728，P=0.009）。
与传统吻合术相比，改良 Blumgart 吻合术降低了从生化漏出到临床相关术后胰瘘和术后胰瘘相关再手术的转化率，并缩短了住院时间。此外，改良 Blumgart 吻合术是临床相关术后胰瘘发生的独立且阴性预测因素。
