Blumgart Anastomosis After Pancreaticoduodenectomy. A Comprehensive Systematic Review, Meta-Analysis, and Meta-Regression

Background The superiority of Blumgart anastomosis (BA) over non-BA duct to mucosa (non-BA DtoM) still remains under debate. Methods We performed a systematic search of studies comparing BA to non-BA DtoM. The primary endpoint was CR-POPF. Postoperative morbidity and mortality, post-pancreatectomy h...

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Bibliographic Details
Published in:World journal of surgery 2021-06, Vol.45 (6), p.1929-1939
Main Authors: Ricci, Claudio, Ingaldi, Carlo, Alberici, Laura, Pagano, Nico, Mosconi, Cristina, Marasco, Giovanni, Minni, Francesco, Casadei, Riccardo
Format: Article
Language:English
Subjects:
Abdominal Surgery
Anastomosis
Anastomosis, Surgical
Cardiac Surgery
Gastric emptying
General Surgery
Hemorrhage
Humans
Medicine
Medicine & Public Health
Meta-analysis
Morbidity
Mucosa
Pancreatectomy
Pancreatic Fistula
Pancreaticoduodenectomy
Pancreaticoduodenectomy - adverse effects
Postoperative Complications - epidemiology
Reoperation
Scientific Review
Surgery
Surgical outcomes
Systematic review
Thoracic Surgery
Vascular Surgery
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Summary:Background The superiority of Blumgart anastomosis (BA) over non-BA duct to mucosa (non-BA DtoM) still remains under debate. Methods We performed a systematic search of studies comparing BA to non-BA DtoM. The primary endpoint was CR-POPF. Postoperative morbidity and mortality, post-pancreatectomy hemorrhage (PPH), delayed gastric emptying (DGE), reoperation rate, and length of stay (LOS) were evaluated as secondary endpoints. The meta-analysis was carried out using random effect. The results were reported as odds ratio (OR), risk difference (RD), weighted mean difference (WMD), and number needed to treat (NNT). Results Twelve papers involving 2368 patients: 1075 BA and 1193 non-BA DtoM were included. Regarding the primary endpoint, BA was superior to non-BA DtoM (RD = 0.10; 95% CI: −0.16 to −0.04; NNT = 9). The multivariate ORs' meta-analysis confirmed BA's protective role (OR 0.26; 95% CI: 0.09 to 0.79). BA was superior to DtoM regarding overall morbidity (RD = −0.10; 95% CI: −0.18 to −0.02; NNT = 25), PPH (RD = −0.03; 95% CI −0.06 to −0.01; NNT = 33), and LOS (− 4.2 days; −7.1 to −1.2 95% CI). Conclusion BA seems to be superior to non-BA DtoM in avoiding CR-POPF.
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-021-06039-x