Modified Blumgart Anastomosis (Compressing the / Шинэ санаа Шинэ нээлт

ABSTRACT

Background: To minimize the risk of pancreatic fistula development after pancreaticoduodenectomy, we perform a pancreaticojejunostomy procedure that is characterized by compression of the pancreatic stump by the seromuscular layer of the jejunum. Methods: To suture the pancreatic parenchyma to the jejunal seromuscular layer, we use 4-0 non-absorbent thread and double-ended needles. After insertion of a needle from the posterior surface of the pancreatic parenchyma toward its anterior surface, the serosa of the small intestine is stitched in the direction of the minor axis of the jejunum to approximate the posterior surface of the pancreas. A stitch is made in the posterior parenchymal surface to anchor the suture thread. Two sutures are placed, one at the head of the main pancreatic duct and the other at the bottom of the pancreas.During all-layer suturing of the pancreatic duct to the jejunum, three support threads are placed at the three points of an imaginary equilateral triangle, and sutures are added as needed, depending on the size of the pancreatic duct. Generally, nine sutures are used, fewer when the pancreatic duct is small in diameter. Note that there is a total of four needle tips/threads coming through the anterior surface of the pancreas. After the all-layer suture of the pancreatic duct to the jejunam is tied off, the 4-0 non-absorbent thread that was used to stitch the pancreatic parenchyma to the jejunal seromuscular layer is used to stitch the seromuscular layer of the small intestine in the direction of the minor axis to approximate the anterior wall of the small intestine.Although it appears as though pressure is being applied when the branch of the pancreatic duct that is exposed to the pancreatic cut end is closed, ligation should be gentle. Study Patients We conducted a study of 222 patients who underwent pancreaticojejunostomy. The patients comprised three groups treated during three different time periods, and we compared pancreatic fistula rates between these groups. The first group was treated between 2005 and 2009, the second group was treated between 2010 and 2012, and fast-track perioperative management was undertaken in this group, and the third group was treated between 2012 and 2014, and anastomosis was achieved in this group by serosal compression of the pancreatic stump. Results: The incidences of grade B/C pancreatic fistula were 27.8% (25/90) in the first group, 10.3% (9/87) in the second group, and 2.2% (1/45) in the third group (p<0.001). Conclusion: The risk of serious pancreatic fistula at the pancreatic stump can be markedly reduced by creation of a modified Blumgart pressure anastomosis.