Modified Blumgart Anastomosis in Patients Undergoing Robotic Pancreaticoduodenectomy: The Results of a Preliminary Experience

Backgrounds: Several anastomoses have been described for the reconstruction of the pancreatic stump after pancreaticoduodenectomy. No technique showed a superiority over the others in terms of post-operative pancreatic fistula formation (POPF) in open neither during a minimally invasive approach. Methods: We compared the surgical outcomes of fourteen patients classified as high-risk for POPF who underwent a Blumgart anastomosis (BA) with that of patients who underwent a Cattell-Warren (CW). A 1:1 case-matched analysis was performed according to the variables of the risk score for post-operative pancreatic fistula (POPF) formation. Results: The overall operative time was similar (373±115 vs 398±127 min, p=0.567) while fashioning of the CW anastomosis required a longer time (38±21 vs 29±10, p<0.05). The overall morbidity rate was comparable among the two groups (p=0.273), while the incidence of clinically relevant-POPF was lower in the BA group (0 vs 3, p<0.05). No differences were observed in reoperation rate (p=0.445) and in postoperative length of stay (11.5 vs 12.6, p=0.367). Conclusion: The BA anastomosis is a potential alternative to the CW technique in a high-risk population for POPF formation. It shows benefits in terms of shorter anastomotic time and lower rate of clinically relevant-POPF.