Modified Blumgart Suturing Technique for Remnant Closure After Distal Pancreatectomy: a Propensity Score-Matched Analysis View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2015-10-23

AUTHORS

Tsutomu Fujii, Suguru Yamada, Kenta Murotani, Hiroyuki Sugimoto, Masashi Hattori, Mitsuro Kanda, Hideki Takami, Goro Nakayama, Shuji Nomoto, Michitaka Fujiwara, Akimasa Nakao, Yasuhiro Kodera

ABSTRACT

Despite recent advances in surgical techniques including staple closure and ultrasonic devices, the reported incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains high. Therefore, we devised a new strategy in which the pancreatic stump is enveloped with the elevated jejunum (EJ) by a modified Blumgart anastomotic technique. Eighty-one patients who underwent open DP with splenectomy from January 2008 to December 2014 were enrolled. Comparisons were made between 42 patients who underwent placement of an EJ patch using the modified Blumgart method after scalpel transection and 39 patients who underwent scalpel transection alone, using unmatched and propensity score-matched analysis. After 25 patients from each group were selected by propensity score matching, the EJ patch technique was significantly associated with a lower incidence of clinically relevant POPF (P = 0.036). Multivariate analysis showed that the EJ patch was an independent predictor of a lower incidence of POPF (odds ratio, 0.16; 95 % confidence interval, 0.01–0.48; P = 0.017) as was the estimated remnant pancreatic volume. Addition of the EJ patch improves postoperative outcomes in patients who undergo open DP with splenectomy by scalpel transection and hand-sewn closure of the pancreatic remnant. More... »

PAGES

374-384

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11605-015-2980-3

DOI

http://dx.doi.org/10.1007/s11605-015-2980-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1050893932

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/26497190


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32 schema:description Despite recent advances in surgical techniques including staple closure and ultrasonic devices, the reported incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains high. Therefore, we devised a new strategy in which the pancreatic stump is enveloped with the elevated jejunum (EJ) by a modified Blumgart anastomotic technique. Eighty-one patients who underwent open DP with splenectomy from January 2008 to December 2014 were enrolled. Comparisons were made between 42 patients who underwent placement of an EJ patch using the modified Blumgart method after scalpel transection and 39 patients who underwent scalpel transection alone, using unmatched and propensity score-matched analysis. After 25 patients from each group were selected by propensity score matching, the EJ patch technique was significantly associated with a lower incidence of clinically relevant POPF (P = 0.036). Multivariate analysis showed that the EJ patch was an independent predictor of a lower incidence of POPF (odds ratio, 0.16; 95 % confidence interval, 0.01–0.48; P = 0.017) as was the estimated remnant pancreatic volume. Addition of the EJ patch improves postoperative outcomes in patients who undergo open DP with splenectomy by scalpel transection and hand-sewn closure of the pancreatic remnant.
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40 Blumgart anastomotic technique
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44 Modified Blumgart Suturing Technique
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48 anastomotic technique
49 closure
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52 distal pancreatectomy
53 elevated jejunum
54 fistula
55 group
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57 incidence
58 independent predictors
59 jejunum
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62 multivariate analysis
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64 open distal pancreatectomy
65 outcomes
66 pancreatectomy
67 pancreatic fistula
68 pancreatic remnant
69 pancreatic stump
70 pancreatic volume
71 patch technique
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73 patients
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75 postoperative outcomes
76 postoperative pancreatic fistula
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78 propensity score
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82 remnant closure
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85 scalpel transection
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