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Laparoscopic-adapted Blumgart pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy

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Abstract

Background

Laparoscopic pancreaticoduodenectomy (LPD) is a complex procedure that is becoming increasingly popular among surgeons. Postoperative pancreatic fistula (POPF) remains the most feared specific complication in reconstruction after PD. The Blumgart anastomosis (BA) has been established as one of the safest anastomosis for pancreas remnant reconstruction, with low rates of POPF and postoperative complications. The procedure for performing this anastomosis by laparoscopic approach has not been reported to date.

Methods

We describe our technique of LPD with laparoscopic-adapted BA (LapBA) and present the results obtained. A case-matched analysis with open cases of BA is also reported.

Results

Since February 2013 to February 2016, thirteen patients were operated of LapBA. An equivalent cohort of open PD patients was obtained by matching sex, ASA, pancreas consistency and main pancreatic duct diameter. Severe complications (grades III–IV) and length of stay were significantly lesser in LapBA group. No differences in POPF, readmission, reoperation rate and mortality were detected.

Conclusions

The LapBA technique we propose can facilitate the pancreatic reconstruction after LPD. In this case-matched study, LPD shows superior results than open PD in terms of less severe postoperative complications and shorter length of stay. Randomized control trials are required to confirm these results.

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Abbreviations

PD:

Pancreaticoduodenectomy

OPD:

Open pancreaticoduodenectomy

LPD:

Laparoscopic pancreaticoduodenectomy

OBA:

Open Blumgart anastomosis

LBA:

Laparoscopic-adapted Blumgart anastomosis

PG:

Pancreaticogastrostomy

PJ:

Pancreaticojejunostomy

POPF:

Postoperative pancreatic fistula

DTM:

Duct-to-mucosa

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Authors and Affiliations

  1. Unit of Hepato-Biliary-Pancreatic Surgery, Department of General and Digestive Surgery, Hospital del Mar, Autonomous University of Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain

    Ignasi Poves, Olga Morató, Fernando Burdío & Luís Grande

  2. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    Ignasi Poves, Fernando Burdío & Luís Grande

Authors
  1. Ignasi Poves
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  2. Olga Morató
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  3. Fernando Burdío
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  4. Luís Grande
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Correspondence to Ignasi Poves.

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Disclosures

Poves I and Morató O performed research and wrote the paper; Poves I and Burdío F contributed to study conception and design; and Burdío F and Grande L contributed to critical revision of the manuscript for important intellectual content.

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Poves, I., Morató, O., Burdío, F. et al. Laparoscopic-adapted Blumgart pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy. Surg Endosc 31, 2837–2845 (2017). https://doi.org/10.1007/s00464-016-5294-y

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  • DOI: https://doi.org/10.1007/s00464-016-5294-y

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