A Modified Blumgart Pancreaticojejunostomy in Laparoscopic Pancreaticoduodenectomy: A Retrospective Study

BACKGROUND: Laparoscopic pancreaticoduodenectomy (LPD) is increasingly performed, but clinically relevant postoperative pancreatic fistula (CR-POPF) remains a major complication. This study evaluated a modified Blumgart pancreaticojejunostomy (PJ) technique in LPD. METHODS: This retrospective study included 217 consecutive patients who underwent LPD between January 2021 and December 2025. 102 in the modified Blumgart group and 115 in the conventional Blumgart group. 1:1 propensity score matching (PSM) was performed using 12 covariates based on the Fistula Risk Score model. The primary outcome was CR-POPF. Univariate and multivariate logistic regression identified independent risk factors, and exploratory subgroup analyses were conducted. RESULTS: After PSM, 78 patients remained in each group. In the entire cohort, the modified group had a significantly lower CR-POPF rate (6.9% vs. 17.4%, p = 0.019) and fewer abdominal infections (5.9% vs. 15.7%, p = 0.022). After PSM, CR-POPF remained lower in the modified group (7.7% vs. 17.9%, p = 0.055), and abdominal infection remained significantly reduced (6.4% vs. 16.7%, p = 0.045). Multivariate analysis identified PDAC pathology (OR = 0.233, p = 0.022) and modified anastomosis (OR = 0.383, p = 0.041) as independent protective factors in the entire cohort. Subgroup analysis revealed that the protective effect was shown in patients with a main pancreatic duct > 3 mm (OR = 0.176, p = 0.008; PSM cohort: OR = 0.169, p = 0.027; p for interaction = 0.070 and 0.111, respectively). CONCLUSIONS: The modified Blumgart PJ is safe and effective in LPD, reducing CR-POPF and abdominal infection. Its protective effect is shown in patients with a main pancreatic duct > 3 mm.