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Updated: Apr 15, 2026
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Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
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Does modified Blumgart pancreatojejunostomy compared with original Blumgart pancreatojejunostomy decrease the rate of
Fernando Revoredo Rego1, Gustavo Reaño Paredes1, Fritz Kometter Barrios1
1Department of Surgery, Pancreas Spleen and Retroperitoneum Surgery Service, Guillermo Almenara Irigoyen National Hospital, Lima, Perú.
Annals of Hepato-Biliary-Pancreatic Surgery
|April 14, 2026
Summary
The modified Blumgart technique (mB-PJ) did not significantly reduce clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD) compared to the standard Blumgart technique (B-PJ). Preoperative cholangitis, soft pancreas, and small pancreatic duct size are key CR-POPF predictors.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Clinically relevant postoperative pancreatic fistula (CR-POPF) is a major cause of morbidity following pancreatoduodenectomy (PD).
- No universally accepted technique exists for pancreato-enteric anastomosis, a critical step in PD.
- The Blumgart technique (B-PJ) and its modified version (mB-PJ) are surgical methods for pancreato-enteric anastomosis.
Purpose of the Study:
- To compare the efficacy of the modified Blumgart technique (mB-PJ) against the standard Blumgart technique (B-PJ) in reducing CR-POPF incidence.
- To evaluate secondary outcomes including major morbidity, length of hospital stay, reoperation rates, readmission, and mortality.
- To identify independent predictors of CR-POPF after PD.
Main Methods:
- Retrospective analysis of patients undergoing PD between January 2011 and December 2021.
- Comparison of CR-POPF incidence between B-PJ and mB-PJ groups.
- Propensity score matching (PSM) to control for confounding variables and selection bias.
Main Results:
- A total of 292 patients were included; after PSM, no significant difference in CR-POPF incidence was found between mB-PJ (15.8%) and B-PJ (18.9%) (p=0.566).
- Secondary endpoints, including major morbidity, length of stay, reoperation, readmission, and mortality, showed no statistical differences between the groups.
- Independent predictors for CR-POPF included preoperative cholangitis (OR: 4.906), soft pancreas (OR: 4.259), and main pancreatic duct size ≤ 3 mm (OR: 5.229).
Conclusions:
- The modified Blumgart technique (mB-PJ) is not superior to the standard Blumgart technique (B-PJ) in preventing CR-POPF after PD.
- Preoperative cholangitis, pancreatic texture (soft), and main pancreatic duct diameter are significant independent risk factors for developing CR-POPF.
- Further research may be needed to optimize pancreato-enteric anastomosis techniques to minimize CR-POPF.
