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.