title: Blumgart's technique of pancreaticojejunostomy: an appraisal.
abstract: BACKGROUND
  Although mortality of Whipple's pancreaticoduodenectomy (WPD) is reduced to <5%, morbidity still remains between 30 and 50%. Pancreaticojejunal anastomosis remains the main cause of morbidity. Blumgart anastomosis using transpancreatic U sutures has been proposed to decrease the leak rate and its associated morbidity. We analyzed the results of Blumgart anastomosis applied in consecutive cases of WPD.
  
  
  METHODS
  Of 189 patients with periampullary or pancreatic cancer admitted, 100 patients underwent WPD. Except for 2 patients (no duct identified preoperatively), all patients underwent pancreaticojejunostomy by the Blumgart anastomotic technique. The records of 98 patients were analyzed for pancreatic leak and its related complications using the definitions given by the International Study Group for Pancreatic Surgery.
  
  
  RESULTS
  Of 98 patients, 63 were men. The mean operative time was 390 min (270-690 min) and blood loss was 275 ml (100-1,000 ml). Overall mortality was 3.06%. The clinically significant pancreatic anastomotic failure leak was seen in only 7 (7.14%) cases (grade B, n = 4; grade C, n = 3) with one patient requiring relaparotomy due to leak. Only one patient died due to a leak-related complication.
  
  
  CONCLUSIONS
  Blumgart pancreaticojejunal anastomosis can be routinely used for reconstruction in WPD. It is a technically simple procedure and is associated with low rates of fistula and its related complications.
authors.affiliation: Department of Gastrointestinal Surgery, GB Pant Hospital, New Delhi, India.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Mishra
authors.forename: Sundeep Singh
authors.initials: SS
authors.lastname: Saluja
authors.forename: Monica
authors.initials: M
authors.lastname: Gupta
authors.forename: Rajesh
authors.initials: R
authors.lastname: Rajalingam
authors.forename: Premanand
authors.initials: P
authors.lastname: Pattnaik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology* / Q000517:prevention & control; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D016063:Blood Loss, Surgical; D002277:Carcinoma / Q000601:surgery; D018281:Cholangiocarcinoma / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D004379:Duodenal Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D010193:Pancreaticojejunostomy / Q000009:adverse effects* / Q000379:methods*; D013536:Suture Techniques; D013997:Time Factors; D055815:Young Adult