title: The Tight Adaptation at Pancreatic Anastomosis Without Parenchymal Laceration: An Institutional Experience in Introducing and Modifying the New Procedure.
abstract: BACKGROUND
  Among the types of pancreatic anastomosis used after pancreatoduodenectomy (PD), Blumgart type reconstruction has rapidly been distributed for its theoretical reasonableness, including secure tight adaptation of jejunal wall and pancreatic parenchyma without cause of parenchymal laceration. The clinical appropriateness of our modified Blumgart method was demonstrated by comparing to that of Kakita method.
  
  
  METHODS
  Retrospective analysis of 156 patients underwent elective open PD, reconstructed former 78 patients with the Kakita method, utilizing a full-thickness penetrating suture for tight stump adhesion. The later 78 patients were treated with the modified Blumgart method, which involved clamping the pancreatic parenchymal stump by the jejunal seromuscular layers with horizontal mattress-type penetration sutures. Evaluated variables were the rate of pancreatic fistula (PF) and the length of postoperative hospital stay (POHS).
  
  
  RESULTS
  The rate of ISGPF grade B+C PF was 29/78 (37.2%) in the Kakita group and 16/78 (20.5%) in the Blumgart group (P=0.033). The median POHS for the Kakita group was 23 days, whereas that for the Blumgart group was 16 days (P<0.001), one of the shortest value among Japanese high-volume centers. There was no perioperative intensive hemorrhage or deaths in either group.
  
  
  CONCLUSIONS
  A unique concept of Blumgart pancreatic anastomosis, i.e., utilizing the jejunum as an interstitial cushion to prevent pancreatic laceration at the knot site, has become realistic through a simple "one step" modification. This technique, also providing flexible handling space at main pancreatic duct anastomosis, should contribute to the improved PF prevention and shortening the POHS.
authors.affiliation: Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan, tatoda@md.tsukuba.ac.jp.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Oda
authors.forename: Shinji
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Miyamoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Shimomura
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Fukunaga
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kohno
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ohshiro
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Akashi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Enomoto
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohkohchi
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods*; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors