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

Abstract

Backgrounds/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 mB-PJ (18.9% vs. 15.8%, p = 0.566). No statistical differences were observed in the secondary endpoints. Independent predictors of CR-POPF 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.