Comparison of postoperative results between types of pancreaticoenteral anastomosis after pancreaticoduodenectomy

Sep 29, 2026

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Retrospective analysis of 365 patients undergoing pancreatectomy with pancreaticoenteral anastomosis at two academic institutions evaluated five anastomotic techniques and their postoperative complication profiles. The study compared pancreatic fistula (POPF), particularly clinically significant grades B/C, plus hospital stay, timing of oral intake, and ascites duration. Modified Blumgart showed the shortest stay and fastest return of oral intake, with the lowest clinically significant POPF incidence. Habitual alcohol use, high preoperative creatinine, and specific anastomosis and drainage factors independently increased POPF risk, and early oral intake emerged as protective.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Background

Study background, rationale and knowledge

Methods

Patient cohort and anastomosis groups

Results

Hospital stay, oral intake, POPF and ascites

Independent predictors of POPF

Conclusions

Optimal technique and postoperative recommendations

Keywords

Comparison of postoperative results between types of pancreaticoenteral anastomosis after pancreaticoduodenectomy Atsushi Nanashima 1,2^, Junichi Arai2^, Naoya Imamura 1^, Masahide Hiyoshi 1^, Yuki Tsuchimochi 1^, Takashi Wada1^, Takeomi Hamada1 1Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan; 2Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan Contributions: (I) Conception and design: J Arai, M Hiyoshi; (II) Administrative support: A Nanashima; (III) Provision of study materials or patients: N Imamura, Y Tsuchimochi, T Wada, T Hamada; (IV) Collection and assembly of data: A Nanashima; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Atsushi Nanashima, degree. Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotake Kihara, Miyazaki 889-1602, Japan; Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. Email: [a_nanashima@med.miyazaki-u.ac.jp](a_nanashima@med.miyazaki-u.ac.jp). Background: Pancreatic anastomosis has been developed, and each anastomosis has its pros and cons. This study investigated the prevalence of postoperative complications, particularly pancreatic fistula (POPF), among five types of pancreatoenteric anastomoses to determine the optimal anastomosis for patients undergoing pancreatectomy. Methods: This study retrospectively and consecutively analyzed the data of 365 patients who underwent pancreatectomy with pancreaticoenteral anastomosis at two academic institutions from 1994 to 2024. Pancreaticogastrostomy via invagination was performed in 24 patients (group PG) . For pancreaticojejunalanastomosis, we performed an end-to-end invagination procedure on eight patients (group PJI), two-layer suturing procedure on 96 patients (group PJT), Kakita procedure on 55 patients (group K), and modified Blumgart procedure on 182 patients (group B) . Results: Group B had the shortest hospital stay and fastest resumption of oral intake. Groups PG and PJI exhibited higher grade B/C POPF rates and prolonged ascites. The potential benefits of group B included reduced hospitalization period and enhanced recovery owing to decreased POPF rates. Habitual alcohol consumption and high preoperative creatinine levels increased the risk of POPF, whereas external drainage issues and blood loss contributed to prolonged ascites. In particular, habitual alcohol consumption [relative risk (RR) =2.42], group K anastomosis (RR =2.79), soft pancreatic texture (RR =2.48), delayed oral intake (≥4 days; RR =2.78), and complete external drainage (RR =8.68) were independent predictors of POPF. Conclusions: Modified Blumgart procedure is an optimal pancreaticoenteral anastomosis technique for avoiding POPF. Early oral intake has emerged as a protective factor, highlighting its role in improving postoperative outcomes. Surgeons should prioritize intraoperative blood conservation, perioperative nutritional support, and appropriate anastomotic selection to enhance surgical success. Keywords: Pancreatoenteric anastomosis; pancreatectomy; pancreatic fistula; postoperative complication; modified Blumgart procedure Submitted Aug 25, 2025. Accepted for publication Nov 07, 2025. Published online Dec 24, 2025. doi: 10.21037/gs-2025-380 View this article at: [https://dx.doi.org/10.21037/gs-2025-380](https://dx.doi.org/10.21037/gs-2025-380) ^ ORCID: Atsushi Nanashima, 0000-0002-3246-557X; Junichi Arai, 0009-0009-5544-2096; Naoya Imamura, 0000-0002-8358-5328; Masahide Hiyoshi, 0000-0002-2392-7787; Yuki Tsuchimochi, 0000-0002-3466-3764; Takashi Wada, 0000-0002-1046-19

FAQs

What was the main purpose of comparing different pancreaticoenteral anastomosis types?

To determine the optimal anastomosis by assessing postoperative complication prevalence, especially pancreatic fistula (POPF), among five anastomotic techniques after pancreatectomy.

Which anastomosis technique showed the best overall postoperative outcomes?

The modified Blumgart procedure, with the shortest hospital stay, fastest resumption of oral intake, and the lowest incidence of clinically significant POPF.

What factors increased the risk of POPF in this study?

Habitual alcohol consumption, high preoperative creatinine levels, group K anastomosis, soft pancreatic texture, delayed oral intake (≥4 days), and complete external drainage were independent predictors of POPF.

Sep 29, 2026

Uploaded by Aditya