The Application Of Modified Blumgart Pancreaticojejunostomy Technique In Pancreaticoduodenectomy

Objective:Pancreaticoduodenectomy(PD)is a surgical treatment mainly used in the clinical management of benign and malignant diseases involving the pancreatic head,ampulla of Vater,duodenum,and distal common bile duct.It is a complex abdominal surgery with high postoperative complication rates,including postoperative pancreatic fistula(POPF)as the most common one.The pancreaticojejunostomy technique are important factors affecting the incidence of POPF,and there is currently no conclusive evidence to indicate an absolute advantage of any pancreaticojejunostomy technique in reducing POPF incidence.This article aims to evaluate the clinical value and applicability of the Modified Blumgart Pancreaticojejunostomy technique in PD by comparing the clinical data of the conventional end-to-side invaginated pancreaticojejunostomy group with the Modified Blumgart Pancreaticojejunostomy group in a retrospective study of a single center.The study attempts to provide some reference and standards for the selection of pancreaticojejunostomy methods.Method:This study collected clinical data of 69 patients who underwent pancreaticoduodenectomy at the Affiliated Hospital of Guilin Medical University from December 1,2017 to December 1,2022.Among them,38 patients received conventional end-to-side invaginated pancreaticojejunostomy(conventional group)and 31 patients received Modified Blumgart Pancreaticojejunostomy(modified group).A retrospective comparative study was conducted to compare the general clinical data of the two groups of patients,including preoperative clinical data such as gender,age,Body mass index(BMI),Alanine transaminase(ALT),Albumin(ALB),Total bilirubin(TBIL),and whether they had underlying diseases(hypertension,diabetes,coronary heart disease).Intraoperative clinical data such as total operation time,pancreaticojejunostomy time,intraoperative blood loss,pancreatic texture,and pancreatic duct diameter were also collected.Postoperative clinical data such as pathological histology type,postoperative complications(pancreatic fistula,biliary fistula,delayed gastric emptying,abdominal infection,abdominal bleeding),and length of hospital stay were analyzed retrospectively by comparing the clinical indicators and the incidence of relevant postoperative complications between the two groups of patients(with the main endpoint being the incidence of postoperative pancreatic fistula).The clinical data of patients who underwent the two different pancreaticojejunostomy methodss were compared and analyzed retrospectively.Result:In this study,there were no significant differences found between the two groups in terms of age,gender,height,weight,BMI,liver functionindexes(ALT,ALB,TBIL),concomitant diseases,pancreatic texture,intraoperative blood loss,pathological type,delayed gastric emptying(DEG),abdominal infection,post-pancreatectomy hemorrhage(PPH),and hospitalization time(all P>0.05).Regarding the operation time,the average timeof the modified group(278.68±39.05 min)was shorter than that of the conventional group(278.68±39.05 min),but P=0.300,which was not statistically significant(P>0.05).However,for the pancreaticojejunostomy time,theaverage time of the modified group(23.15±1.68 min)was shorter than thatof the conventional group(27.04±2.74 min),and P=0.002,which was statistically significant(P<0.05).Studies have suggested that pancreatic ductdiameterisa risk factorfor postoperative pancreatic fistula(POPF).Comparedwith the conventional group,the modified group tended to have a lower incidence of POPF(including "biochemical fistula," grade B POPF,and grade C POPF),although there was no significant difference in grade A pancreaticfistula(biochemical fistula),which was not statistically significant.However,the difference between grade B POPF and grade C POPF was significant and statistically significant,indicating that the modified group could potentially reduce the incidence of POPF.Conclusion:The Modified Blumgart Pancreaticojejunostomy technique can shorten the anastomotic time to a certain extent compared to the conventional end-to-side invaginated pancreaticojejunostomy,and is a reliable choice for PD.with effective assurance of surgical safety and reduced pancreatic fistula rate.Surgeons should choose a reasonable PD surgical plan for each patient based on their condition,intraoperative pancreatic status,and their own surgical experience.Such individualized strategies are crucial for improving the safety of PD surgery.