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Updated: Nov 12, 2025
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Blumgart Anastomosis After Pancreaticoduodenectomy. A Comprehensive Systematic Review, Meta-Analysis, and
Claudio Ricci1,2, Carlo Ingaldi3,4, Laura Alberici3,4
1Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, , S.Orsola-Malpighi Hospital, University of Bologna, Policlinico S.Orsola-Malpighi Via Massarenti n.9, 40138, Bologna, Italy. claudiochir@gmail.com.
Background:
The superiority of Blumgart anastomosis (BA) over non-BA duct to mucosa (non-BA DtoM) still remains under debate.
Methods:
We performed a systematic search of studies comparing BA to non-BA DtoM. The primary endpoint was CR-POPF. Postoperative morbidity and mortality, post-pancreatectomy hemorrhage (PPH), delayed gastric emptying (DGE), reoperation rate, and length of stay (LOS) were evaluated as secondary endpoints. The meta-analysis was carried out using random effect. The results were reported as odds ratio (OR), risk difference (RD), weighted mean difference (WMD), and number needed to treat (NNT).
Results:
Twelve papers involving 2368 patients: 1075 BA and 1193 non-BA DtoM were included. Regarding the primary endpoint, BA was superior to non-BA DtoM (RD = 0.10; 95% CI: -0.16 to -0.04; NNT = 9). The multivariate ORs' meta-analysis confirmed BA's protective role (OR 0.26; 95% CI: 0.09 to 0.79). BA was superior to DtoM regarding overall morbidity (RD = -0.10; 95% CI: -0.18 to -0.02; NNT = 25), PPH (RD = -0.03; 95% CI -0.06 to -0.01; NNT = 33), and LOS (- 4.2 days; -7.1 to -1.2 95% CI).
Conclusion:
BA seems to be superior to non-BA DtoM in avoiding CR-POPF.
