Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
School of Medicine, South China University of Technology, Guangzhou, 51000, China.
BMC Surg. 2023 Nov 10;23(1):339. doi: 10.1186/s12893-023-02248-4.
Blumgart pancreaticojejunostomy (PJ) was shown to be an effective method for pancreaticojejunostomy in open pancreaticoduodenectomy. But the original Blumgart method is involved in complicated and interrupted sutures, which may not be suitable for the laparoscopic approach. In this study, we introduced a simplified Blumgart method for laparoscopic pancreaticojejunostomy.
We retrospectively reviewed 90 cases of pancreaticoduodenectomy in our institute from 2019 to 2022. Among them, 32 patients received LPD with simplified Blumgart PJ, while 29 received LPD with traditional duct-to-mucosal anastomosis (the Cattel-Warren technique) and 29 received OPD with traditional duct-to-mucosal anastomosis. And the time length for PJ and the surgical outcome were compared in these three groups.
The simplified Blumgart pancreaticojejunostomy was accomplished in all 32 cases with no conversion to open surgery due to improper sutures. And the time length for laparoscopic simplified Blumgart pancreaticojejunostomy was 26 ± 8.4 min, which was shorter than laparoscopic traditional ductal to mucosa pancreaticojejunostomy (39 ± 13.7 min). Importantly, the overall incidence for POPF and grade B&C POPF rate in the laparoscopic simplified Blumgart method group were 25% and 9.38% respectively, which were lower than the other two groups. Moreover, we performed univariate analysis and multivariate analysis and found soft pancreas, pancreatic ductal diameter < = 3 mm and intraoperative blood loss were independent risk factors for POPF after PD.
Our data suggest that the simplified Blumgart method is a feasible and reliable method for laparoscopic PJ which deserves further validation.
Blumgart 胰肠吻合术（PJ）已被证明是一种有效的开腹胰十二指肠切除术胰肠吻合术方法。但原始的 Blumgart 方法涉及复杂和间断的缝合，可能不适合腹腔镜方法。在这项研究中，我们引入了一种简化的腹腔镜胰肠吻合术 Blumgart 方法。
我们回顾性分析了 2019 年至 2022 年我院 90 例胰十二指肠切除术患者的临床资料。其中 32 例患者接受简化 Blumgart PJ 的腹腔镜胰十二指肠切除术（LPD），29 例患者接受传统的胆管黏膜吻合术（Cattel-Warren 技术）的腹腔镜胰十二指肠切除术（LPD），29 例患者接受传统胆管黏膜吻合术的开腹胰十二指肠切除术（OPD）。比较三组患者 PJ 的时间长度和手术结果。
32 例简化 Blumgart 胰肠吻合术均顺利完成，无因缝合不当而转为开腹手术。腹腔镜简化 Blumgart 胰肠吻合术的时间长度为 26±8.4 分钟，短于腹腔镜传统胆管胰肠吻合术（39±13.7 分钟）。重要的是，腹腔镜简化 Blumgart 方法组的总 POPF 发生率和 B&C 级 POPF 发生率分别为 25%和 9.38%，均低于其他两组。此外，我们进行了单因素和多因素分析，发现胰腺质地软、胰管直径≤3mm 和术中出血量是 PD 后发生 POPF 的独立危险因素。
我们的数据表明，简化的 Blumgart 方法是一种可行且可靠的腹腔镜 PJ 方法，值得进一步验证。
