Novel modified blumgart anastomosis reduces clinically relevant pancreatic fistula after pancreaticoduodenectomy: a retrospective study using inverse probability of treatment weighting.
Lin Ye, Zhiyuan Jian, Wanrong Yue, Jun Weng, Qingrong Mo, Gaoshi Li, Renjian Li, Hao Shi, Haozhe Zhou, Yaqun Yu
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引用次数: 0
Abstract
Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) remains a significant complication after pancreaticoduodenectomy (PD). We implemented a novel modified Blumgart pancreaticojejunostomy (m-BPJ) technique with anchoring approach and omental reinforcement, and evaluated its efficacy compared to conventional pancreaticojejunostomy (c-PJ).
Methods: This retrospective study included patients who underwent PD from January 2020 to December 2024. Patients were divided into m-BPJ (n = 85) and c-PJ (n = 130) groups. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. The primary endpoint was CR-POPF incidence. Secondary endpoints included operative parameters, postoperative recovery indicators, and complications.
Results: After IPTW, CR-POPF incidence was significantly lower in the m-BPJ group (6.4% vs. 15.6%, p = 0.031). The m-BPJ group showed shorter PJ anastomosis time (21.1 ± 5.5 vs. 29.0 ± 7.4 min, p < 0.001), operation time (287.5 ± 45.3 vs. 304.2 ± 53.6 min, p = 0.023), and less intraoperative blood loss (325 vs. 375 mL, p = 0.041). Postoperative recovery was accelerated, with faster gastrointestinal function recovery (3.2 ± 1.1 vs. 4.0 ± 1.4 days, p < 0.001), earlier oral intake (4.6 ± 1.3 vs. 5.7 ± 1.8 days, p < 0.001), and reduced hospital stay (12 vs. 14 days, p = 0.009). Multivariate analysis confirmed m-BPJ as an independent protective factor against CR-POPF (OR 0.34, 95% CI 0.13-0.82, p = 0.018), while BMI ≥25 kg/m² (OR 2.23, 95% CI 1.07-4.65, p = 0.033), soft pancreatic texture (OR 3.25, 95% CI 1.47-7.12, p = 0.003), and pancreatic duct diameter <3 mm (OR 2.35, 95% CI 1.12-4.97, p = 0.024) were independent risk factors. Subgroup analysis revealed greatest benefit in high-risk patients.
Conclusions: Our m-BPJ technique with anchoring approach and omental reinforcement significantly reduces CR-POPF after PD, particularly in high-risk patients. This technique demonstrates improved surgical efficiency and postoperative recovery, providing a valuable option for safer pancreatic reconstruction following PD.
背景：临床相关的术后胰瘘（CR-POPF）仍然是胰十二指肠切除术（PD）后的一个重要并发症。我们实施了一种新的改良Blumgart胰空肠吻合术（m-BPJ）技术，采用锚定入路和网膜强化，并评估其与传统胰空肠吻合术（c-PJ）的疗效。方法：本回顾性研究纳入了2020年1月至2024年12月接受PD治疗的患者。患者分为m-BPJ组（n = 85）和c-PJ组（n = 130）。应用治疗加权逆概率（IPTW）来平衡基线特征。主要终点为CR-POPF发生率。次要终点包括手术参数、术后恢复指标和并发症。结果：IPTW后，m-BPJ组CR-POPF发生率明显降低（6.4%比15.6%,p = 0.031）。m-BPJ组吻合时间短（21.1±5.5 min vs 29.0±7.4 min, p p = 0.023），术中出血量少（325 mL vs 375 mL, p = 0.041）。术后恢复加快，胃肠功能恢复较快（3.2±1.1 vs. 4.0±1.4 d, p p p = 0.009）。多因素分析证实m- bpj是预防CR-POPF的独立保护因素（OR 0.34, 95% CI 0.13-0.82, p = 0.018），而BMI≥25 kg/m²（OR 2.23, 95% CI 1.07-4.65, p = 0.033）、胰腺质地柔软（OR 3.25, 95% CI 1.47-7.12, p = 0.003）和胰管直径p = 0.024是独立危险因素。亚组分析显示高危患者获益最大。结论：我们的m-BPJ技术结合锚定入路和网膜强化可显著降低PD后的CR-POPF，特别是在高危患者中。该技术提高了手术效率和术后恢复，为PD后更安全的胰腺重建提供了有价值的选择。
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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