Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2019; 25(20): 2514-2523
Published online May 28, 2019. doi: 10.3748/wjg.v25.i20.2514
Effect of Blumgart anastomosis in reducing the incidence rate of pancreatic fistula after pancreatoduodenectomy
Ya-Tong Li, Han-Yu Zhang, Cheng Xing, Cheng Ding, Wen-Ming Wu, Quan Liao, Tai-Ping Zhang, Yu-Pei Zhao, Meng-Hua Dai
Ya-Tong Li, Han-Yu Zhang, Cheng Xing, Cheng Ding, Wen-Ming Wu, Quan Liao, Tai-Ping Zhang, Yu-Pei Zhao, Meng-Hua Dai, Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
Author contributions: Li YT and Zhang HY are co-first authors of this article; Li YT wrote the paper; Li YT, Zhang HY, Xing C, and Ding C collected and analyzed the data; Wu WM, Liao Q, Zhang TP, Zhao YP, and Dai MH operated the surgeries; Dai MH guided the study.
Institutional review board statement: The study was reviewed and approved by the Peking Union Medical College Hospital Institutional Review Board.
Informed consent statement: All the patients involved in our study gave written informed consent.
Conflict-of-interest statement: The authors disclose that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Meng-Hua Dai, MD, Doctor, Professor, Department of General Surgery, Peking Union Medical College Hospital, No. 1, Shuai Fu Yuan, Dongcheng District, Beijing 100730, China. daimh@pumch.cn
Telephone: +86-10-6915-2600 Fax: +86-10-6915-6021
Received: March 14, 2019
Peer-review started: March 14, 2019
First decision: April 4, 2019
Revised: May 2, 2019
Accepted: May 8, 2019
Article in press: May 8, 2019
Published online: May 28, 2019
ARTICLE HIGHLIGHTS
Research background

Postoperative pancreatic fistula (POPF) is a serious complication of pancreaticoduodenectomy (PD). Surgical procedure of pancreaticojejunostomy (PJ) in PD is closely related to POPF, and the traditional method is embedding the remnant pancreatic end into the small intestine. Since the incidence rate of POPF remains high, Blumgart anastomosis, a new U-style duct-to-mucosa procedure of PJ, was proposed. However, there were no enough data to support the benefits of Blumgart anastomosis in reducing the rate of POPF. Thus, our present study would give more evidence, analysis, and suggestions to make the postoperative recovery after PD better.

Research motivation

We analyzed and explained the details and benefits of Blumgart anastomosis compared with traditional embedded PJ in PD. We proved that a better choice of PJ procedure could certainly reduce the incidence rate of POPF, and subsequently reduce the mortality of pancreatic surgery.

Research objectives

We suggested to add the surgical methods into the risk calculator of POPF, and the technique of Blumgart anastomosis should be further promoted.

Research methods

In this observational study, a retrospective analysis was made to compare the preoperative, intraoperative, perioperative, and long-term follow-up courses between 201 patients with Blumgart anastomosis and 90 patients with traditional embedded PJ in PD.

Research results

Blumgart anastomosis took less operative time, less days of PJ drainage tube placement, and less postoperative hospital stay. The overall complications were reduced, including the incidence rate of severe POPF. These results indicated the advantages of Blumgart anastomosis in PD, and non-inferiority in long-term status. More studies, especially prospective clinical trials, are needed to confirm our findings.

Research conclusions

The new findings of this study are the detailed benefits of Blumgart anastomosis, and the new theory, original insights, and new hypotheses are to take surgical methods into the consideration of the risk calculator of POPF. The appropriate summarizations of this study are the benefits of Blumgart anastomosis in intraoperative and postoperative courses, as well as its non-inferiority features in the long-term statuses. There were neither basic experiments nor new statistical methods used. Blumgart anastomosis needs further promotion in the future.

Research perspectives

To further promote Blumgart anastomosis, more studies, especially prospective randomized controlled trials, are needed. Besides, since surgical methods are important in reducing postoperative complications of PD, new PJ procedures could be proposed based on Blumgart anastomosis.