1.Does modified Blumgart pancreatojejunostomy compared with original Blumgart pancreatojejunostomy decrease the rate of clinically relevant postoperative pancreatic fistula? A single-center propensity score-matched analysis
Fernando Revoredo REGO ; Gustavo Reaño PAREDES ; Fritz Kometter BARRIOS ; Tongbo WANG ; Guillermo Herrera CHÁVEZ ; Luis Villanueva ALEGRE ; Jorge Tang SING ; Mónica Uribe LEÓN ; Wuilber Ludeña HURTADO ; José Arenas GAMIO ; Sheyla Alfaro ITA ; Vanessa Bermúdez ALFARO ; Liliana Fonseca CAVERO ; Félix Carrasco MASCARO ; Italo Landeo ALIAGA ; Samy Castillo FLORES ; José de Vinatea de CÁRDENAS
Annals of Hepato-Biliary-Pancreatic Surgery 2026;30(2):234-243
Background:
s/Aims: The most common cause of morbidity following pancreatoduodenectomy (PD) is the clinically relevant postoperative pancreatic fistula (CR-POPF). There is currently no universally accepted technique for pancreato-enteric anastomosis. This study aims to compare the Blumgart technique (B-PJ) with the modified Blumgart technique (mB-PJ).
Methods:
This is a retrospective study involving patients who underwent PD between January 2011 and December 2021. The primary endpoint was to compare the incidence of CR-POPF. Secondary endpoints included major morbidity, length of postoperative stay, rates of reoperation, hospital readmission, postoperative mortality, and predictors of CR-POPF. Propensity score matching (PSM) was employed to minimize potential selection bias.
Results:
The study included 292 patients. After PSM, the incidence of CR-POPF was not significantly different between B-PJ and mBPJ (18.9% vs. 15.8%, p = 0.566). No statistical differences were observed in the secondary endpoints. Independent predictors of CRPOPF included preoperative cholangitis (odds ratio [OR]: 4.906, 95% confidence interval [CI]: 1.440–16.713, p = 0.011), soft pancreas (OR: 4.259, 95% CI: 1.043–17.376, p = 0.043), and main pancreatic duct size ≤ 3 mm (OR: 5.229, 95% CI: 1.865–14.656, p = 0.002).
Conclusions
This study did not demonstrate that mB-PJ is superior to B-PJ in reducing the incidence of CR-POPF. Factors such as soft pancreas, main pancreatic duct size, and preoperative cholangitis are identified as independent risk factors for CR-POPF.
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