Wrapping the Stump of the Gastroduodenal Artery Using the Falciform Ligament During Pancreaticoduodenectomy

An analysis of risk factors for pancreatic fistula after pancreaticoduodenectomy: clinical impact of bile juice infection on day 1

“…One patient developed massive intra-abdominal bleeding on day 7 and died of hypovolemic condition. Another patient was found to have Guillain-Barre syndrome on day 10 Univariate and multivariate analysis of risk factors for grade B and grade C POPF In the univariate analysis, seven variables, gender (male), gender (≥65), BMI (≥20), disease (other than pancreatic cancer), the size of the main pancreatic duct (<3 mm), portal vein resection (not performed), and bile juice infection on day 1, were identified as significant risk factors for grade B and grade C POPF (Table 1). No statistical difference was found in the incidence of grade B or grade C POPF between patients undergoing only PTCD (n= 63) and patients undergoing only retrograde drainage (n=30; 25% vs 27%, p=0.73).…”

“…Patients received preoperative intravenous antibiotic prophylaxis using a second-generation cephalosporin. After removal of the pancreatic head, we routinely wrapped the stump of the gastroduodenal artery using the falciform ligament to prevent the bleeding caused by pancreatic leakage [10]. The surgical procedures consisted of standard Whipple procedure (SW) in 58 patients and pylorus-preserving pancreaticoduodenectomy (PPPD) in 162 patients.…”

Pancreatoduodenectomy - Preventing Complications

“…Occasionally this results in inflammation of the fat due to activation of pancreatic enzymes and can cause intra-abdominal collections. It has been shown to prevent post-operative hemorrhagic complications in various studies following pancreatic leak [82][83][84]. A retrospective study by Tani et al revealed higher incidence of POPF in omental wrapping group compared to nonwrapping (42.8 % versus 37.3 %) [85].…”

Analysis of Risk Factors for Delayed Gastric Emptying (DGE) after 387 Pancreaticoduodenectomies with Usage of 70 Stapled Reconstructions

“…After the removal of the pancreatic head, we routinely wrapped the stump of the gastroduodenal artery using the falciform ligament to prevent the bleeding caused by the pancreatic leakage. 19 Surgical procedures included pylorus-preserving PD (PPPD) in 296 patients, classical Whipple procedure (CW) or subtotal stomach-preserving PD (SSPPD) in 83 patients, PPPD plus limited hepatic resection in one patient, CW plus limited hepatic resection in two patients, and PPPD plus extended right hemihepatectomy in five patients. CW and SSPPD were not strictly distinguished, and the resection of the pyloric ring and antrum was performed according to the tumor extension or to the preference of the attending surgeon.…”