Wrapping in pancreatic surgery: a systematic review

Ramia, José Manuel; Plaza, Roberto de la; Adel, Farah; Ramiro, C.; Arteaga, Vladimir; García-Parreño, Jorge

doi:10.1111/ans.12491

Cited by 27 publications

(25 citation statements)

References 16 publications

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“…[7] One group suggested wrapping the PJ and the local retroperitoneal vessels with omentum and/or the falciform ligament, a procedure popular in Austral-Asia but rarely used in Europe or the USA. [8] Fibrin glue and other topical hemostatic occlusive agents have also been evaluated as adjuncts to help “seal” the anastomosis making it water tight, and thereby preventing a POPF. [9] Somatostatin and its multiple synthetic analogues (Octreotide, Vapreotide, Pasireotide, etc.)…”

Section: Introductionmentioning

confidence: 99%

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pedrazzoli¹

2017

Medicine

168

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Background:Pancreatoduodenectomy (PD) is one of the most technically demanding operations challenging surgeons, and a postoperative pancreatic fistula (POPF) can complicate an otherwise uneventful postoperative (PO) course. This review examined the methods and procedures used to prevent postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD).Methods:A comprehensive systematic search of the literature was performed using PubMed (Medline), Embase, Web of science, and the Cochrane databases for studies published between January 1, 1990 and December 31, 2015. English language articles involving at least 100 patients undergoing PDs carried out in centers performing at least 10 PDs/y were screened for data regarding the Grade of any POPFs according to the definition of the International Study Group on Pancreatic Fistula (ISGPF) and the overall rate of PO mortality related to POPF.Results:We reviewed 7119 references through the major databases, and an additional 841 studies were identified by cross-checking the bibliographies of the full-text articles retrieved. After excluding 7379 out of 7960 studies, because they did not meet the eligibility criteria, the full texts of 581 articles were examined; 96 studies were excluded at this point, because they concerned partially or totally duplicate data that had already been reported. The remaining 485 articles were screened carefully for POPF-related mortality and POPF Grades as defined by the ISGPF. Of the 485 articles, 208 reported the POPF-related PO mortality rate and 162 the Grades (A, B, and C) of POPFs in 60,739 and 54,232 patients, respectively. The POPF-related mortality rates after pancreatojejunostomy and pancreatogastrostomy were similar but were less (0.5% vs. 1%; P = .014) when an externally draining, trans-anastomotic stent was placed intraoperatively. The incidence of the different Grades of POPF Grade was quite variable, but Grade C POPFs were associated with a PO mortality rate of 25.7% (range 0–100%).Conclusions:The POPF-related mortality rate has remained at approximately 1% over the past 25 years. Only externally draining, trans-anastomotic stents decreased the POPF-related mortality rate. However, adequately designed venting drains were never tested in randomized controlled trials (RCTs).

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Section: Introductionmentioning

confidence: 99%

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pedrazzoli¹

2017

Medicine

168

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“…Various techniques have been suggested to reduce the chance of pseudoaneurysm formation, including the ‘wrapping’ technique, in which the exposed retroperitoneal vessels are covered with omentum or the falciform ligament. Others have suggested leaving 1 cm at the origin of the GDA stump to minimize the likelihood of lytic pancreatic juices coming into contact with the vessel.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the incidence, presentation and management of gastroduodenal artery pseudoaneurysm after pancreatic resection

Brodie

Kocher

2019

BJS Open

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BackgroundGastroduodenal artery (GDA) pseudoaneurysm is a serious complication following pancreatic resection, associated with high morbidity and mortality rates. This review aimed to report the incidence of GDA pseudoaneurysm after pancreatic surgery, and describe clinical presentation and management.MethodsMEDLINE and Embase were searched systematically for clinical studies evaluating postoperative GDA pseudoaneurysm. Incidence was calculated by dividing total number of GDA pseudoaneurysms by the total number of pancreatic operations. Additional qualitative data related to GDA pseudoaneurysm presentation and management following pancreatic resection were extracted and reviewed from individual reports.ResultsNine studies were selected for systematic review involving 4227 pancreatic operations with 55 GDA pseudoaneurysms, with a reported incidence of 1·3 (range 0·2–8·3) per cent. Additional data were extracted from 39 individual examples of GDA pseudoaneurysm from 14 studies. The median time for haemorrhage after surgery was at 15 (range 4–210) days. A preceding complication in the postoperative period was documented in four of 21 patients (67 per cent), and sentinel bleeding was observed in 14 of 20 patients (70 per cent). Postoperative complications after pseudoaneurysm management occurred in two‐thirds of the patients (14 of 21). The overall survival rate was 85 per cent (33 of 39).ConclusionGDA pseudoaneurysm is a rare yet serious cause of haemorrhage after pancreatic surgery, with high mortality. The majority of the patients had a preceding complication. Sentinel bleeding was an important clinical indicator.

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“…It is stated that hemorrhages arising from the cut pancreatic surfaces are important in etiology (22). Binding the vascular structures in pairs, using vessel sealers, and performing omental patches are suggested methods to prevent hemorrhages arising from pancreatic vessels.…”

Section: Discussionmentioning

confidence: 99%

Postoperative hemorrhage complications following the Whipple procedure

Dılek¹,

Özşay²,

Acar³

et al. 2019

Turk J Surg

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Objective: Although the Whipple operation is an essential surgical technique, its high morbidity (30% to 60%) and mortality (5%) are problems to be addressed. The incidence of postoperative hemorrhage has been reported between 5% and 16% in the literature. In this study, the data and results regarding postoperative hemorrhage complications from our clinic were evaluated. Material and Methods: The files of 185 patients who had undergone Whipple operation in our hospital in the last five years were evaluated retrospectively, and the causes of hemorrhage were attempted to be determined. Results: It was found that 6 out of the 13 (7%) patients who had hemorrhage died. In six of there 13 cases, hemorrhage occurred due to fistulas from the portal vein, gastroduodenal artery, and pancreatic arteries at variable periods. Two cases were found to have developed disseminated intravascular coagulation as a result of sepsis. Early intervention was performed in two cases who bled from the meso veins and in one case who bled from the portal vein. Laparotomy and hemostasis were performed in a patient who bled from the gastric anastomosis line. In a patient who had been taking low molecular weight heparin, bleeding from the drains and nasogastric tube stopped following the cessation of the drug. Conclusion: Preventive procedures such as connection of the vascular structures, use of vascular sealants, omental patching during surgery, and reducing the risk of complications by using somatostatin analogs were performed to prevent hemorrhages after Whipple operations. In addition to standard methods, angiography and embolization have emerged as effective methods in the diagnosis and treatment of hemorrhages. Furthermore, determination and elimination of independent risk factors, such as jaundice, affecting fistula formation and bleeding in the perioperative period, is important for prevention.

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Wrapping in pancreatic surgery: a systematic review

Abstract: On the basis of the literature available at present, we cannot recommend the use of wrapping with omentum and/or FL in pancreatic surgery. Prospective randomized studies applying a systematic wrapping technique are needed in order to establish whether its use should be generalized.

Cited by 27 publications

References 16 publications

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Systematic review of the incidence, presentation and management of gastroduodenal artery pseudoaneurysm after pancreatic resection

Postoperative hemorrhage complications following the Whipple procedure

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