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Completely 3-dimensional laparoscopic pancreaticoduodenectomy with modified Blumgart pancreaticojejunostomy: an analysis of 100 consecutive cases

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Abstract

Purpose

Although laparoscopic pancreaticoduodenectomy (LPD) is increasingly performed in high-volume centers, pancreaticojejunostomy (PJ) is still the most challenging procedure. Pancreatic anastomotic leakage remains a major complication after PD. Thus, various technical modifications regarding PJ, such as the Blumgart technique, have been attempted to simplify the procedure and minimize anastomotic leakage. Three-dimensional (3D) laparoscopic systems have been shown to be particularly helpful in performing difficult and precise tasks. We present a modified Blumgart anastomosis in 3D-LPD and investigate its clinical outcomes.

Methods

A retrospective analysis of 100 patients who underwent 3D-LPD with modified Blumgart PJ from September 2018 to January 2020 was conducted. Data on the preoperative characteristics, operative outcomes, and postoperative characteristics of the patients were collected and analyzed.

Results

The mean operative time and duration of PJ were 348.2 and 25.1 min, respectively. The mean estimated blood loss was 112 mL. The overall rate of postoperative complications over Clavien‒Dindo classification III was 18%. The incidence of clinically relevant postoperative pancreatic fistula was 11%. The median postoperative hospital stay was 14.2 days. Only one patient required reoperation (1%), and no patient died in the hospital or 90 days after the operation. High BMI, small main pancreatic duct diameter, and soft pancreatic consistency had a significant influence on the occurrence of CR-POPF.

Conclusions

The surgical outcome of 3D-LPD with modified Blumgart PJ seems to be comparable to other studies in terms of operation time, blood loss, hospital stay, and complication incidence. We consider the modified Blumgart technique in 3D-LPD to be novel, reliable, safe, and favorable for PJ in the PD procedure.

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Data Availability

Data in the manuscript is available.

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Funding

The work was supported by the National Natural Science Foundation of China (Nos. 81871950, 81702871, and 81972725); Clinical and Scientific Innovation Project of Shanghai Hospital Development Center (SHDC12018109; SHDC2020CR1006A); Scientific Innovation Project of Shanghai Education Committee (2019–01-07–00-07-E00057); Shanghai Municipal Commission of Health and Family Planning (No. 2018YQ06); and Shanghai Municipal Science and Technology Commission (19QA1402100).

Author information

Authors and Affiliations

  1. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 201321200032, China

    Liu Wensheg, Ji Shunrong, Xu Wenyan, Shi Yihua, Liu Mengqi, Li Zheng, Zhuo Qifeng, Xu Xiaowu & Yu Xianjun

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

    Liu Wensheg, Ji Shunrong, Xu Wenyan, Shi Yihua, Liu Mengqi, Li Zheng, Zhuo Qifeng, Xu Xiaowu & Yu Xianjun

  3. Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China

    Liu Wensheg, Ji Shunrong, Xu Wenyan, Shi Yihua, Liu Mengqi, Li Zheng, Zhuo Qifeng, Xu Xiaowu & Yu Xianjun

  4. Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China

    Liu Wensheg, Ji Shunrong, Xu Wenyan, Shi Yihua, Liu Mengqi, Li Zheng, Zhuo Qifeng, Xu Xiaowu & Yu Xianjun

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  1. Liu Wensheg
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  2. Ji Shunrong
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  3. Xu Wenyan
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  4. Shi Yihua
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  6. Li Zheng
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  7. Zhuo Qifeng
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  8. Xu Xiaowu
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  9. Yu Xianjun
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Liu Wensheng, Zhuo Qifeng, Liu Mengqi, and Li Zheng. Critically revising the work for important intellectual content was performed by Ji Shunrong, Xu Wenyan, Shi Yihua, Xu Xiaowu, and Yu Xianjun. The first draft of the manuscript was written by Liu Wensheng, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Liu Wensheg, Zhuo Qifeng, Xu Xiaowu or Yu Xianjun.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Fudan University Shanghai Cancer Center approved this study.

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The authors declare no competing interests.

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Wensheg, L., Shunrong, J., Wenyan, X. et al. Completely 3-dimensional laparoscopic pancreaticoduodenectomy with modified Blumgart pancreaticojejunostomy: an analysis of 100 consecutive cases. Langenbecks Arch Surg 408, 126 (2023). https://doi.org/10.1007/s00423-023-02763-1

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