The modified Blumgart anastomosis is associated with a lower incidence of clinically relevant postoperative pancreatic fistula and a shorter anastomotic time: a prospective cohort study with a historical control group

Introduction The modified Blumgart anastomosis (mBA) is widely used for pancreaticojejunostomy; however, its clinical benefits remain uncertain. Methods We prospectively enrolled 179 consecutive patients scheduled to undergo pancreaticoduodenectomy (PD) at our institution between February 2016 and December 2018; 125 underwent PD with mBA and were included in the analysis. Short-term outcomes were compared with those of a historical cohort of 103 patients who underwent conventional anastomosis (CA) between April 2012 and January 2016. Results Baseline demographic characteristics did not differ significantly between the two groups. The incidences of clinically relevant postoperative pancreatic fistula (POPF) and grade B/C postpancreatectomy hemorrhage (PPH) were significantly lower in the mBA group than in the CA group (7.2% vs. 24.3%, p < 0.001; 4.0% vs. 11.7%, p = 0.028, respectively). The anastomotic time was also significantly shorter in the mBA group (p < 0.001), whereas the overall operative time did not differ significantly (p = 0.206). Multivariable analysis showed that mBA was independently associated with lower odds of clinically relevant POPF, and the incidence remained significantly lower after propensity score matching (PSM). Discussion The mBA technique may reduce shear stress on the pancreatic parenchyma, potentially contributing to the lower incidences of POPF and PPH. Conclusions The mBA was associated with lower incidences of clinically relevant POPF and PPH and with a shorter anastomotic time, suggesting potential clinical advantages of this technique.