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Liu GH, Tan XY, Li JX, Zhong GH, Zhai JW, Li MY. A modified Blumgart anastomosis with a simple and practicable procedure after laparoscopic pancreaticoduodenectomy: our center's experience. BMC Surg 2023; 23:349. [PMID: 37974183 PMCID: PMC10655365 DOI: 10.1186/s12893-023-02221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/06/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Laparoscopic pancreaticoduodenectomy(LPD) has become the goal of lots of minimally invasive surgical centers in recent years. Postoperative pancreatic fistula(POPF) is still the barrier to attaining the above goal. Thus, improving anastomosis techniques to reduce the rate of POPF has been a hotspot of surgery. Blumgart pancreaticojejunostomy is considered one of the best anastomosis procedures, with low rates of POPF. However, the original Blumgart pancreaticojejunostomy method is not easy for laparoscopic operation. In consequence, we modified a Blumgart pancreaticojejunostomy technique with a simple and practicable procedure and applied to LPD. METHODS We collected and retrospectively analyzed the perioperative clinical data of patients who underwent modified Blumgart anastomosis from February 2017 to September 2022. The above patients included 53 cases in open pancreaticojejunostomy(OPD) and 58 cases in LPD. After propensity score matching, 44 cases were included for comparison in each group. RESULTS After propensity score matching, the average time for pancreaticojejunostomy was about 30 min in the LPD group. The Clinically relevant POPF(CR-POPF) rate was 9.1%. The length of postoperative hospitalization was 13.1 days. Compared with the OPD group, The CR-POPF rate in the LPD group are not significant differences. But the postoperative length of hospital stay was significantly shorter in the LPD group. Besides, there were no other severely postoperative complications between two groups. CONCLUSION The modified Blumgart anastomosis technique applied to LPD in our Center not only has simple and convenient properties but also low rate of CR-POPF. And this method may be a good choice for surgeons to begin to carry out LPD.
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Affiliation(s)
- Guo-Hua Liu
- Department of Hepatobiliary Surgery, Affiliated Hospital, Guangdong Medical University, Zhanjiang, Guangdong, 524000, China
| | - Xiao-Yu Tan
- Department of Hepatobiliary Surgery, Affiliated Hospital, Guangdong Medical University, Zhanjiang, Guangdong, 524000, China
| | - Jia-Xing Li
- Department of Hepatobiliary Surgery, Affiliated Hospital, Guangdong Medical University, Zhanjiang, Guangdong, 524000, China
| | - Guo-Hui Zhong
- Department of Hepatobiliary Surgery, Affiliated Hospital, Guangdong Medical University, Zhanjiang, Guangdong, 524000, China
| | - Jing-Wei Zhai
- Department of Hepatobiliary Surgery, Affiliated Hospital, Guangdong Medical University, Zhanjiang, Guangdong, 524000, China
| | - Ming-Yi Li
- Department of Hepatobiliary Surgery, Affiliated Hospital, Guangdong Medical University, Zhanjiang, Guangdong, 524000, China.
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Shimomura O, Oda T, Miyazaki Y, Furuya K, Doi M, Takahashi K, Kim J, Moue S, Owada Y, Ogawa K, Ohara Y, Akashi Y, Enomoto T, Hashimoto S. Pancreatic juice outflow in pancreatojejunostomy monitoring with the inter-anastomosis drainage tube; a retrospective observational study. BMC Surg 2022; 22:274. [PMID: 35836157 PMCID: PMC9284870 DOI: 10.1186/s12893-022-01669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pancreatic fistula remains the biggest problem in pancreatic surgery. We have previously reported a new pancreatojejunostomy method using an inter-anastomosis drainage (IAD) suction tube with Blumgart anastomosis for drainage of the pancreatic juice leaking from the branched pancreatic ducts. This study aimed to evaluate the postoperative outcomes of our novel method, in pancreatojejunostomy and investigate the nature of the inter-anastomosis space between jejunal wall and pancreas parenchyma. METHODS This retrospectively study consist of 282 pancreatoduodenectomy cases, including 86 reconstructions via the Blumgart method plus IAD (B + IAD group) and 196 cases reconstructed using the Blumgart method alone (B group). Postoperative outcomes and the amylase value and the volume of the drainage fluids were compared between the two groups. The IAD tube was placed to collect amylase-rich fluid from the inter-anastomosis space during operative procedure between the jejunal wall and pancreatic stump. RESULTS The daily IAD drainage volume and the amylase level was significantly higher in patients with a soft pancreas (vs hard pancreas; 16.5 vs. 10.0 mL/day, p = 0.012; 90,900 vs. 1634 IU/L, p < 0.001, respectively). The mean amylase value of IAD collection in 86 cases of B + IAD group was 63,100 IU/L. The incidence of clinically relevant pancreatic fistula grade B and C (23.2% vs. 23.0%, p = 0.55) and the hospital stay was similar between the groups (median 17 vs. 18 days, p = 0.55). In 176 patients with soft pancreas, the incidence of pancreatic fistula grade B and C (33.3% vs. 35.3%, p = 0.67) and the hospital stay was also similar between the groups (median 22.5 vs. 21 days, p = 0.81). CONCLUSIONS Positive effect of the IAD method observed in the pilot cases was not reproduced in the current study. IAD tube objectively demonstrated the existence of amylase-rich discharge at the anastomosis site, and countermeasures to eliminate this liquid are highly desired for preventing pancreatic fistula, especially in patients with soft pancreatic texture. Trial registration Retrospectively registered.
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Affiliation(s)
- Osamu Shimomura
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tatsuya Oda
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. .,Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan.
| | - Yoshihiro Miyazaki
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kinji Furuya
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Manami Doi
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazuhiro Takahashi
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Jaejeong Kim
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shoko Moue
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yohei Owada
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Koichi Ogawa
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yusuke Ohara
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshimasa Akashi
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tsuyoshi Enomoto
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinji Hashimoto
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Sun PJ, Yu YH, Li JW, Cui XJ. A Novel Anastomosis Technique for Laparoscopic Pancreaticoduodenectomy: Case Series of Our Center's Experience. Front Surg 2021; 8:583671. [PMID: 33777996 PMCID: PMC7994857 DOI: 10.3389/fsurg.2021.583671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Laparoscopic pancreaticoduodenectomy has developed rapidly in recent years. Postoperative pancreatic fistula is still the most dangerous complication of laparoscopic pancreaticoduodenectomy. Baumgart pancreaticojejunostomy is considered one of the safest anastomosis procedures, with low rates of pancreatic fistula. We modified Blumgart pancreaticojejunostomy and applied the modified procedure during laparoscopic pancreaticoduodenectomy. The modified procedure entailed a longitudinal U-shaped suture through the pancreas for anastomosis of the pancreatic duct and the jejunal mucosa. Methods: We prospectively collected and retrospectively analyzed the data of 120 patients who underwent laparoscopic pancreaticoduodenectomy from January 2016. The total operative time, time for complete pancreaticojejunostomy, postoperative pancreatic fistula rate, postoperative delayed gastric emptying, postoperative bleeding, postoperative length of hospital stays, and mortality within 90 days after surgery were analyzed. An analysis of laparoscopic pancreaticojejunostomy compared with open pancreaticojejunostomy is also reported. Results: In the laparoscopic pancreaticojejunostomy group, the average total operative time, the average time for complete pancreaticojejunostomy, and the average intraoperative blood loss were 271 min, 35.3 min, and 184 ml, respectively. The total postoperative clinically relevant pancreatic fistula rate was 9.2% (Grade B and C fistulas). The incidence rates of postoperative delayed gastric emptying and postoperative biliary fistula were ~2.5 and 1.7%, respectively. The postoperative bleeding rate was 0.83%, and the average postoperative indwelling time of the abdominal drainage tube was 7.3 days. The postoperative length of hospital stay was 10.8 days, and the mortality rate within 90 days after surgery was 0.83%. The rates of clinically relevant postoperative clinically relevant pancreatic fistula are comparable between laparoscopic and open surgery, there were no other severe postoperative complications in either group. The mean postoperative length of hospital stay was significantly shorter in the laparoscopic pancreaticojejunostomy group. Conclusion: The modified laparoscopic-adapted Blumgart anastomosis simplifies and facilitates the creation of the pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy. The rates of clinically relevant postoperative pancreatic fistula are comparable with those obtained by open surgery, and length of stay are shoter.
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Affiliation(s)
- Pi-Jiang Sun
- Department of Hepatobiliary Surgery, Weihai Central Hospital Affiliated to Qingdao University, Weihai, China
| | - Yan-Hua Yu
- Department of Dermatology, Weihai Central Hospital Affiliated to Qingdao University, Weihai, China
| | - Jian-Wei Li
- Institute of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xi-Jun Cui
- Department of Hepatobiliary Surgery, Weihai Central Hospital Affiliated to Qingdao University, Weihai, China
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