The GaMBK Anastomosis: A Novel and Simplified Technique for Pancreaticojejunostomy

We present a modification of the Blumgart and Kakita techniques, which we call GaMBK (Gamboa-Modified Blumgart and Kakita) anastomosis. Our primary objective was to evaluate the association between clinically relevant postoperative pancreatic fistula (POPF, grades B/C) and the type of pancreaticojejunal anastomosis performed during pancreaticoduodenectomy (GaMBK vs Blumgart).

From June 2021 to June 2022, the Blumgart anastomosis was performed, and from July 2022 to March 2024, the GaMBK technique was implemented. A total of 38 patients (15 men and 23 women) who underwent pancreaticoduodenectomy for malignant disease were included in this historical cohort study.

The median pancreatic duct diameter was 3mm in both the GaMBK and Blumgart groups (p=0.79). Median drain amylase levels were 38 U/L (range 30-1200) in the GaMBK group and 34U/L (range 30-3263) in the Blumgart group (p=0.40). Clinically relevant POPF occurred in 8.7% of the GaMBK group and 6.7% of the Blumgart group (p=1). All cases were grade B, and no grade C fistulas were identified. Median hospital stay was 7 days for the GaMBK group and 6 days for the Blumgart group. No association was found between the GaMBK technique and an increased risk of POPF (RR 1.304; 95% CI: 0.129-13.149; p=0.66).

The GaMBK anastomosis is a technically simpler modification of the Blumgart and Kakita techniques that does not increase the risk of clinically relevant POPF.