Novel Modified Blumgart Anastomosis Reduces Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy: A Retrospective Study Using Inverse Probability of Treatment Weighting

Lin Ye^1*Wanrong Yue²Zhiyuan Jian¹Jun Weng¹Qingrong Mo¹Renjian Li¹Hao Shi¹Haozhe Zhou³Yaqun Yu^1*

• ¹Affiliated Hospital of Guilin Medical University, Guilin, China
• ²Guilin People’s hospital, Guilin, Guangxi Zhuang Region, China
• ³Guilin Medical University, Guilin, Guangxi Zhuang Region, China

Pancreaticoduodenectomy (PD) has remained the standard surgical procedure for treating benign and malignant lesions of the pancreatic head and periampullary region since it was first performed by Italian surgeon Codivilla in 1898 [1,2]. Gastrointestinal tract reconstruction following PD represents one of the most challenging aspects of the procedure and significantly influences patient recovery. While surgical mortality rates have decreased to below 5% over the past two decades [3][4][5]. However, due to its complexity and intricate reconstruction steps, the postoperative complication rate remains high ranging from 30 % to 60 % [6][7][8][9].Postoperative pancreatic fistula (POPF) represents a particularly concerning complication following PD. Despite not being the most frequent complication, clinically relevant POPF(CR-POPF) can significantly prolong hospitalization, increase healthcare costs, and potentially trigger life-threatening complications including post-pancreatectomy hemorrhage and intra-abdominal abscesses. Consequently, prevention and management of pancreatic fistula have become priorities in perioperative care [10].In 2002, Blumgart from Memorial Sloan-Kettering Cancer Center developed an innovative pancreaticojejunostomy(PJ) technique for open PD that demonstrated promising clinical outcomes [11,12]. This approach has since been recognized as one of the safest anastomotic methods following PD [13,14]. inspiring various modifications across specialized pancreatic centers worldwide. However, consensus regarding the optimal modified Blumgart technique remains elusive.In response to this challenge, we implemented a novel modified Blumgart PJ technique featuring an anchoring approach and omental reinforcement for open PD [15][16][17][18]. This study aims to evaluate the efficacy of our modified technique compared to conventional PJ in reducing CR-POPF incidence. Secondary outcomes include operative duration, postoperative recovery, and mortality rates. To mitigate the inherent limitations of retrospective analysis, we employed inverse probability of treatment weighting (IPTW) to balance baseline characteristics between groups [19].