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Gastroenterology

No Postoperative Pancreatic Fistula Outcomes Difference Between Blumgart and Pancreatogastrostomy Anastomosis 

Oct 25, 2025

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AT A GLANCE

A new study published in the Annals of Surgery reports that postoperative pancreatic fistula (POPF) outcomes after pancreatogastrostomy (PD) do not differ between patients undergoing Blumgart anastomosis (BA) and pancreatogastrostomy (PG) anastomosis; however, the latter leads to better postoperative quality of life.1

“Postoperative pancreatic fistula (POPF) rates after PD are still high. The only modifiable factor available to improve POPF is the anastomotic technique. BA and PG anastomoses have been previously shown to be feasible and safe, but they have never been compared in a randomized trial,” explain study authors Dorcaratto et al.

As part of a multicenter, randomized, controlled trial across 13 university hospitals, the authors sought to compare POPF rates between BA and invaginating PG after PD. A total of 216 patients presenting with a pancreatic or periampullary neoplasm who underwent PD were enrolled and randomized to a BA or PG group for analysis. The primary endpoint was the rate of POPF, with special assessment of clinically relevant (grade B–C) POPF, and secondary endpoints included postoperative complications, factors related to POPF, and quality of life.

According to the authors, POPF and B–C POPF patients totaled 44% and 28% of the BA group and 34% and 23% of the PG group. Rates of overall complications, severe complications, and mortality were 76%, 24%, and 3.7% respectively, in the BA group, compared with 73%, 32%, and 5.9%, in the PG group, showing no significant differences.

Notably, “soft pancreatic consistency, small preoperative computed tomography Wirsung diameter, patient age, and first postoperative drain amylase concentration were independently associated with B–C POPF,” report the authors.

PG anastomosis led to better quality of life at 9 months.

“BA and PG showed no differences in POPF and postoperative outcomes; B–C POPF can be predicted based on several pre-intra and early postoperative parameters; quality of life favored PG anastomosis at 9 months,” the authors conclude.

Reference

1.     Dorcaratto D, Garcés-Albir M, Palomares-Casasús S, et al. Blumgart anastomosis versus invaginating pancreatogastrostomy for reconstruction after pancreatoduodenectomy: a randomized controlled trial. Ann Surg. 2025;282(5):699–708.