Publication:

A comparative study between Blumgart versus conventional anastomosis for pancreatojejunostomy after pancreaticoduodenectomy

Background Pancreatic leakage is a major cause of postoperative mortality and morbidity after pancreaticoduodenectomy (PD). A recent study introduced Blumgart anastomosis (BA), which minimizes severe complications after PD. This study compares BA with conventional anastomosis (CA) for pancreaticojejunostomy (PJ) after PD.

Methods This prospective observational study includes 50 patients who underwent PD between November 2022 to November 2024 were enrolled in this study in the Hepatobiliary Surgery department of Dhaka Medical College and Hospital, Dhaka, Bangladesh. The patients were divided into two groups according to the anastomosis type. 25 patients underwent anastomosis using CA (group A, conventional anastomosis) and 25 underwent anastomosis using BA (group B, Blumgart anastomosis). The methods were compared in context of postoperative pancreatic fistula (POPF), post pancreatectomy hemorrhage (PPH), and delayed gastric emptying (DGE) to see the overall outcomes of the two techniques.

Results Median duration of operation time was significantly shorter in group B (373.1±102.0 versus 256.4±58.5 min, p<.05), and the number of intraoperative transfusion units was significantly smaller in group B (3.2±2.7 versus 1.7±1.5 units, p<0.05). Statistically significant differences were also observed between group A and B regarding incidence of postoperative pancreatic fistula (POPF) (40.0% versus 20.0%, p=031.) and delayed gastric emptying (DGE) (32.0% versus 4.0%, p=002). There was one mortality which was observed in group-A.

Conclusions BA after PD was associated with a decreased risk of POPF and DGE. Therefore, the results of this study suggest that BA-type PJ is superior to CA-type PJ in terms of postoperative complications.