Modified Blumgart Anastomosis (Compressing the / Шинэ санаа Шинэ нээлт

ABSTRACT

Background: To minimize the risk of pancreatic fistula development afterpancreaticoduodenectomy, we perform a pancreaticojejunostomy procedure thatis characterized by compression of the pancreatic stump by the seromuscularlayer 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 ofa needle from the posterior surface of the pancreatic parenchyma toward itsanterior surface, the serosa of the small intestine is stitched in the direction of theminor axis of the jejunum to approximate the posterior surface of the pancreas. Astitch 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 otherat the bottom of the pancreas.During all-layer suturing of the pancreatic duct tothe jejunum, three support threads are placed at the three points of an imaginaryequilateral triangle, and sutures are added as needed, depending on the size ofthe pancreatic duct. Generally, nine sutures are used, fewer when the pancreaticduct is small in diameter. Note that there is a total of four needle tips/threadscoming through the anterior surface of the pancreas. After the all-layer suture ofthe pancreatic duct to the jejunam is tied off, the 4-0 non-absorbent thread thatwas used to stitch the pancreatic parenchyma to the jejunal seromuscular layeris used to stitch the seromuscular layer of the small intestine in the direction ofthe minor axis to approximate the anterior wall of the small intestine.Although itappears as though pressure is being applied when the branch of the pancreaticduct that is exposed to the pancreatic cut end is closed, ligation should be gentle.Study Patients We conducted a study of 222 patients who underwentpancreaticojejunostomy. The patients comprised three groups treated during threedifferent time periods, and we compared pancreatic fistula rates between thesegroups. The first group was treated between 2005 and 2009, the second groupwas treated between 2010 and 2012, and fast-track perioperative managementwas undertaken in this group, and the third group was treated between 2012 and2014, and anastomosis was achieved in this group by serosal compression of thepancreatic stump.Results: The incidences of grade B/C pancreatic fistula were 27.8% (25/90) in thefirst 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 bemarkedly reduced by creation of a modified Blumgart pressure anastomosis.