Omental flaps reduces complications after pancreaticoduodenectomy

Shah, Omar Javed; Bangri, Sadaf Ali; Singh, Manmohan; Lattoo, Reyaz A; Bhat, Mohammad Y

doi:10.1016/s1499-3872(15)60372-1

Cited by 33 publications

(32 citation statements)

References 21 publications

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“…Previous literatures reported that omental flaps or grafts around various anastomoses after PD could reduce the incidence of POPF and PPH [30,31]. In this study, the statistical analysis did not show a significant benefit of wrapping the GDA stump for preventing PPH.…”

Section: Discussioncontrasting

confidence: 54%

Evaluation of preoperative risk factors for postpancreatectomy hemorrhage

Izumo

Higuchi

Yazawa

et al. 2019

Langenbecks Arch Surg

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Purpose To investigate the risk factors for post-pancreatectomy hemorrhage (PPH). Methods The incidence, outcome, and risk factors for PPH were evaluated in 1169 patients who underwent pancreatectomy. Results The incidence and mortality rates of PPH were 3% and 11% in all pancreatectomies, 4% and 11% in pancreatoduodenectomy, 1% and 20% in distal pancreatectomy, and 3% and 0% in total pancreatectomy, respectively. Male sex [odds ratio (OR) 2.32], body mass index (BMI) ≥ 25 kg/m 2 (OR 3.70), absence of diabetes mellitus (DM; HbA1c ≤ 6.2%; OR 3.62), and pancreatoduodenectomy (OR 3.06) were risk factors for PPH after all pancreatectomies. The PPH incidence was 0%, 1%, 2%, 6%, and 20% in patients with risk scores of 0 (n = 65), 1 (n = 325), 2 (n = 455), 3 (n = 299), and 4 (n = 25), respectively. The differences between risk-score groups 0-2 (2%) and 3-4 (7%) were significant (P < 0.05, OR 4.7). In patients who had undergone pancreatoduodenectomy, postoperative pancreatic fistula (POPF; OR 31.7) and absence of DM (OR 3.45) were risk factors for PPH. There was no significant association between POPF and PPH after distal pancreatectomy (P = 0.28). The incidence of POPF post-pancreatoduodenectomy was 20%. BMI ≥ 25 kg/m 2 (OR 3.17), serum albumin < 3.5 g/dl (OR 1.77), absence of DM (OR 1.75), distal extrahepatic bile duct carcinoma (OR 4.05), and carcinoma of the papilla of Vater (OR 5.19) were risk factors for POPF post-pancreatoduodenectomy. Conclusion Our study clarified the preoperative risk factors for PPH and recommends using a risk scoring system that includes Babsence of DM^for predicting PPH.

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Section: Discussioncontrasting

confidence: 54%

Evaluation of preoperative risk factors for postpancreatectomy hemorrhage

Izumo

Higuchi

Yazawa

et al. 2019

Langenbecks Arch Surg

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“…The prevention of PPH is also a major concern in LPD. The falciform ligament and omental flaps have been used to pack the stump of the GDA during pancreaticoduodenectomy [17][18][19][20][21]. Shah et al [19] and Seyama et al [22] revealed that omental wrapping can significantly reduce postoperative complications, such as post-pancreatectomy hemorrhage, delayed gastric emptying, and biliary fistula.…”

Section: Discussionmentioning

confidence: 99%

Wrapping the stump of the gastroduodenal artery using the ligamentum teres hepatis during laparoscopic pancreaticoduodenectomy: a center’s preliminary experience

Meng

Cai

et al. 2021

BMC Surg

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Background The present study aims to assess the preliminary outcomes of the effectiveness of wrapping the ligamentum teres hepatis (LTH) around the gastroduodenal artery stump for the prevention of erosion hemorrhage after laparoscopic pancreaticoduodenectomy (LPD). Methods We reviewed 247 patients who had undergone LPD between January 2016 and April 2019. The patients were divided into two groups according to whether LTH wrapped the stump of the gastroduodenal artery: group A (119 patients) who underwent the LTH wrapping procedure, and group B (128 patients) who did not undergo the procedure. The perioperative data from the two groups were reviewed to assess the effectiveness of the LTH procedure for the prevention of postpancreatectomy hemorrhage (PPH) and other complications. Results No differences were observed in the clinical characteristics between the two groups. The data from 247 patients were acceptable for analysis: 119 patients underwent wrapping, and 128 patients did not. The incidence of clinically relevant pancreatic fistula (8.4% vs 3.9%), biliary fistula (2.5% vs 1.6%), intra-abdominal infection (10.1% vs 3.9%) and delayed gastric emptying (13.4% vs 16.4%) showed no significant difference between group A and group B. The 90-day mortality and 90-day reoperation rates (0.8% vs 0.8% and 5.0% vs 3.1%) were also similar between group A and group B. Furthermore, postpancreatectomy hemorrhage of Grade B and C occurred in 0 patients (0.0%) in the wrapping group, which was significantly less frequent than the occurrence in the nonwrapping group (7 patients; 5.5%, P = 0.02). Conclusions Wrapping the LTH around the gastroduodenal artery stump after LPD does not reduce the incidence of clinically relevant pancreatic fistula, biliary fistula or delayed gastric emptying. However, this procedure has a trend of reducing the rate of PPH of Grade B and C after LPD and is simple to perform.

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“…Also, omental wrapping was expected to reduce the incidence of the POPF and intra-abdominal hemorrhage[86,87]. Although there have been reports of reduced intra-abdominal complications, this method did not significantly reduce POPF[86-89].…”

Section: Pancreaticoduodenectomymentioning

confidence: 99%

Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery

Kawaida¹,

Kono²,

Hosomura³

et al. 2019

WJG

138

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Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors, such as reconstruction methods, anastomotic techniques, stent usage, prophylactic intra-abdominal drainage, and somatostatin analogs, after pancreaticoduodenectomy and distal pancreatectomy, and we assessed the current status of POPF. In addition, we also discussed the current status of POPF in minimally invasive surgeries, laparoscopic surgeries, and robotic surgeries.

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Omental flaps reduces complications after pancreaticoduodenectomy

Cited by 33 publications

References 21 publications

Evaluation of preoperative risk factors for postpancreatectomy hemorrhage

Evaluation of preoperative risk factors for postpancreatectomy hemorrhage

Wrapping the stump of the gastroduodenal artery using the ligamentum teres hepatis during laparoscopic pancreaticoduodenectomy: a center’s preliminary experience

Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery

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