title: Comparison of Modified Blumgart pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy.
abstract: BACKGROUND
  The aim of this study was to compare perioperative outcomes after Blumgart pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) for pancreatic-enteric reconstruction following pancreaticoduodenectomy.
  
  
  METHODS
  Data of patients undergoing Blumgart PJ and PG were retrieved from prospectively-collected database. Matched patients in each surgical groups were included based on the Callery risk scoring system for clinically relevant postoperative pancreatic fistula (CR-POPF) (grades B and C). Surgical parameters and risks were compared between these two groups.
  
  
  RESULTS
  A total of 206 patients undergoing PD were included. Blumgart PJ was associated with shorter postoperative hospital stay (median (range) 25 (10-99) vs. 27 (10-97) days, P = 0.022). There was no surgical mortality in the Blumgart PJ group, but a 4.9% perioperative mortality in the PG, P = 0.030. The CR-POPF by Blumgrt PG is significantly lower than that by PG for overall patients (7% vs. 20%, P = 0.007), especially for those in intermediate fistula risk zone (6% vs. 21%, P =0.048) and high fistula risk zone (14% vs. 47%, P=0.038).
  
  
  CONCLUSIONS
  Blumgart PJ is superior to PG in terms of pancreatic leakage and surgical mortality. Blumgart PJ can be recommended for pancreatic reconstruction after PD for all pancreatic remnant subtypes.
authors.affiliation: Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan, ROC.
authors.forename: Shin-E
authors.initials: SE
authors.lastname: Wang
authors.affiliation: Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan, ROC.
authors.forename: Shih-Chin
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan, ROC.
authors.forename: Bor-Uei
authors.initials: BU
authors.lastname: Shyr
authors.affiliation: Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan, ROC. Electronic address: ymshyr@gmail.com.
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Shyr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome