title: Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) is the main cause of fatal complications after pancreatoduodenectomy. There is still no universally accepted technique for pancreaticoenterostomy, especially in patients with soft pancreas.
  
  
  METHODS
  Between July 2008 and June 2013, 240 patients who underwent pancreatoduodenectomy were enrolled in this single-institution matched historical control study. To approximate the pancreatic parenchyma to the jejunal seromuscular layer, 120 patients underwent anastomosis using the Kakita method (three or four interrupted penetrating sutures) and 120 underwent anastomosis using the modified Blumgart anastomosis (m-BA) method (one to three transpancreatic/jejunal seromuscular sutures to completely cover the pancreatic stump with jejunal serosa).
  
  
  RESULTS
  The rate of clinically relevant POPF formation was significantly lower in the m-BA group than that in the Kakita group (2.5 vs 36 %; p < 0.001). The duration of drain placement and the length of postoperative hospital stay were significantly shorter in the m-BA group. Multivariate analysis showed that m-BA was an independent predictor of non-formation of POPF (hazard ratio, 0.02; 95 % confidence interval, 0.01-0.08; p < 0.001).
  
  
  CONCLUSIONS
  The m-BA method is safe and simple and improves postoperative outcomes. We suggest that the m-BA is suitable for use as a standard method of pancreaticojejunostomy after pancreatoduodenectomy.
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan, fjt@med.nagoya-u.ac.jp.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamada
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Kanda
authors.forename: Masaya
authors.initials: M
authors.lastname: Suenaga
authors.forename: Hideki
authors.initials: H
authors.lastname: Takami
authors.forename: Masashi
authors.initials: M
authors.lastname: Hattori
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Inokawa
authors.forename: Shuji
authors.initials: S
authors.lastname: Nomoto
authors.forename: Michitaka
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000032:analysis; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D004322:Drainage; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D013536:Suture Techniques; D013997:Time Factors; D055815:Young Adult
chemical_list: D000681:Amylases
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