Independent risk factors for clinically relevant postoperative pancreatic fistula after robotic…

Cohort studyHepatobiliary surgery and nutrition· Aug 2026

Independent risk factors for clinically relevant postoperative pancreatic fistula after robotic pancreatoduodenectomy: the protective role of the modified Blumgart pancreatojejunostomy in a single surgeon retrospective cohort of 220 cases.

Abdallah Iben-Khayat, Amaury Facque, Guillaume Beraud … Haythem Najah

Hepatobiliary & Pancreatic SurgeryCohort studyTreatment

Conventional pancreatojejunostomy is associated with higher pancreatic fistula risk than modified Blumgart technique

Independent risk factors for clinically relevant postoperative pancreatic fistula after robotic pancreatoduodenectomy: the protective role of the modified Blumgart pancreatojejunostomy in a single surgeon retrospective cohort of 220 cases.

Abdallah Iben-Khayat … Haythem Najah

Hepatobiliary surgery and nutrition · Aug 2026

Background

Clinically relevant postoperative pancreatic fistula (clinically relevant postoperative pancreatic fistula) remains the primary driver of morbidity after pancreatoduodenectomy (pancreatoduodenectomy).

Purpose

This study aimed to identify independent risk factors for clinically relevant postoperative pancreatic fistula in a large cohort, with a focus on anastomotic technique and the learning curve.

Methods

We retrospectively analyzed 220 consecutive RPDs performed by a single surgeon between October 2015 and December 2024 at the University Hospital of Orléans.

n = 36

Results

conventional technique tripled fistula risk versus modified Blumgart

OR 3.06 (95% CI 1.12 to 8.40)

CI excludes the null - significant

More results

Clinically relevant postoperative pancreatic fistula occurred in 17% (n=36) of patients.

More results

The cumulative sum curve for clinically relevant postoperative pancreatic fistula, RA-cumulative sum for Clavien-Dindo ≥ III and RA-cumulative sum for textbook outcomes revealed a consistent inflection around the 65th case, coinciding with the near-exclusive adoption of the modified Blumgart anastomosis.

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Conclusion · 1 of 2

In RPD, the modified Blumgart pancreatojejunostomy is independently protective against clinically relevant postoperative pancreatic fistula.

Conclusion · 2 of 2

Standardizing this technique significantly reduces fistula rates and may shorten the learning curve. These findings support adopting the modified Blumgart reconstruction as the default anastomotic strategy during RPD program implementation.

Independent risk factors for clinically relevant postoperative pancreatic fistula after robotic pancreatoduodenectomy: the protective role of the modified Blumgart pancreatojejunostomy in a single surgeon retrospective cohort of 220 cases.

Independent risk factors for clinically relevant postoperative pancreatic fistula after robotic pancreatoduodenectomy: the protective role of the modified Blumgart pancreatojejunostomy in a single surgeon retrospective cohort of 220 cases.

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