Pancreatojejunostomy with modified Blumgart technique for post-pancreatoduodenectomy reconstruction

Abstract

Introduction: Pancreatoduodenectomy is a complex surgery, with morbidity close to 30% and mortality between 1% and 5%. The main contributing factor to morbidity and mortality is postoperative pancreatic fistula (POPF). At present, there is no globally standardized technique for pancreatic reconstruction.

Aim: To determine the prevalence of clinically relevant POPF in a sample of patients who underwent pancreaticojejunal anastomosis reconstruction with Blumgart’s modified technique for post-pancreatoduodenectomy reconstruction at Hospital Hernán Henríquez Aravena between 2014 and 2017.

Material and Method: Case series with follow-up from july 2014 to april 2017. Patients who underwent pancreatic reconstruction with Blumgart’s modified technique were included. The modification consisted of the use of Pledgets® (poly-tetrafluoro-ethylene) at the inicial points in páncreas with the idea of reducing the possibility of tissue tearing. We excluded patients who underwent another reconstruction technique. Clinically relevant POPF (grade B/C) was considered to asses morbidity. Descriptive statistics were used with measures of central tendency and dispersion.

Results: Case series of 12 patients, 9 (75%) were female and 3 (25%) were male. The mean age was 59 ± 8.5 years. The morbidity was 25% and the rate of grade B/C fistula was 0%. All pancreatic fistulas were grade A, not clinically relevant.

Conclusion: The Blumgart’s modified technique seems to be a safe and reproducible technique for pancreticojejunal anastomosis. Key words: pancreatic fistula; blumgart/pancreatoduodenectomy; pancreatic fistula score.