Modified Blumgart Anastomosis (Compressing the
- VernacularTitle:Нойр булчирхай болон нарийн гэдэсний залгаасыг
- Author:
Takehito Otsubo
;
Shinjiro Kobayashi
- Collective Name:Division of Gastroenterological and General Surgery,St. Marianna University School of Medicine
- Publication Type:journal article
- From:Innovation
2014;8(4):102-103
- CountryMongolia
- Language:English
-
Abstract:
Background: To minimize the risk of pancreatic fistula development after
pancreaticoduodenectomy, we perform a pancreaticojejunostomy procedure that
is characterized by compression of the pancreatic stump by the seromuscular
layer of the jejunum.
Methods: To suture the pancreatic parenchyma to the jejunal seromuscular layer,
we use 4-0 non-absorbent thread and double-ended needles. After insertion of
a needle from the posterior surface of the pancreatic parenchyma toward its
anterior surface, the serosa of the small intestine is stitched in the direction of the
minor axis of the jejunum to approximate the posterior surface of the pancreas. A
stitch is made in the posterior parenchymal surface to anchor the suture thread.
Two sutures are placed, one at the head of the main pancreatic duct and the other
at the bottom of the pancreas.During all-layer suturing of the pancreatic duct to
the jejunum, three support threads are placed at the three points of an imaginary
equilateral triangle, and sutures are added as needed, depending on the size of
the pancreatic duct. Generally, nine sutures are used, fewer when the pancreatic
duct is small in diameter. Note that there is a total of four needle tips/threads
coming through the anterior surface of the pancreas. After the all-layer suture of
the pancreatic duct to the jejunam is tied off, the 4-0 non-absorbent thread that
was used to stitch the pancreatic parenchyma to the jejunal seromuscular layer
is used to stitch the seromuscular layer of the small intestine in the direction of
the minor axis to approximate the anterior wall of the small intestine.Although it
appears as though pressure is being applied when the branch of the pancreatic
duct that is exposed to the pancreatic cut end is closed, ligation should be gentle.
Study Patients: We conducted a study of 222 patients who underwent
pancreaticojejunostomy. The patients comprised three groups treated during three
different time periods, and we compared pancreatic fistula rates between these
groups. The first group was treated between 2005 and 2009, the second group
was treated between 2010 and 2012, and fast-track perioperative management
was undertaken in this group, and the third group was treated between 2012 and
2014, and anastomosis was achieved in this group by serosal compression of the
pancreatic stump.
Results: The incidences of grade B/C pancreatic fistula were 27.8% (25/90) in the
first group, 10.3% (9/87) in the second group, and 2.2% (1/45) in the third group
(p<0.001).
Conclusion: The risk of serious pancreatic fistula at the pancreatic stump can be
markedly reduced by creation of a modified Blumgart pressure anastomosis.
