Flooring the Major Vessels with Falciform Ligament to Prevent Post-Pancreatectomy Hemorrhage
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ORIGINAL SCIENTIFIC REPORT
Flooring the Major Vessels with Falciform Ligament to Prevent Post-Pancreatectomy Hemorrhage Kenjiro Okada1 • Yoshiaki Murakami1 • Kenichiro Uemura1 • Naru Kondo1 Naoya Nakagawa1 • Shingo Seo1 • Hiroyuki Otsuka1 • Shinya Takahashi1
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Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background One of the most severe pancreatic surgery complications is post-pancreatectomy hemorrhage (PPH). This study’s aim was to evaluate the efficacy of flooring the major vessels with falciform ligament in preventing PPH after pancreatoduodenectomy (PD). Methods This study was a retrospective review of 500 consecutive patients who underwent PD between Jan 2010 and Dec 2019 at Hiroshima University. Morbidities, including postoperative pancreatic fistula (POPF) or PPH and 90-day mortality, were analyzed. The study cohort was divided into two groups based on the time of surgery (2010–2016 and 2017–2019), i.e., before and after implementation of falciform ligament flooring method. The patient characteristics, operative parameters, clinicopathological factors, morbidity, and mortality were compared between the two periods. Results Morbidity and mortality rates in the entire cohort were 21% and 1.4%, respectively. The incidence of Grade B/C POPF and PPH was 9.0% and 3.8%, respectively. There was no significant difference between the two periods with respect to Grade B/C POPF, morbidity rate, and mortality rate; however, the rate of Grade B/C PPH significantly decreased from 5.2 to 1.6% p = .027. On multivariate analysis, the absence of the falciform ligament flooring method was an independent PPH risk factor p = .003. Conclusions Falciform ligament flooring method may help decrease the incidence of PPH after PD.
Abbreviations PD Pancreatoduodenectomy POPF Postoperative pancreatic fistula DGE Delayed gastric emptying PPH Post-pancreatectomy hemorrhage GDA Gastroduodenal artery CRP C-reactive protein 95% CI 95% Confidence intervals SDs Standard deviations MPD Main pancreatic duct & Kenjiro Okada [email protected] 1
Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan
CT OR
Computed tomography Odds ratio
Introduction Pancreatoduodenectomy (PD) is one of the most complex procedures in gastroenterological surgery. Over the last two decades, there has been a progressive improvement in surgical techniques as well as PD outcomes. In high-volume centers, the post-PD mortality rate decreased to \5% [1–8]. However, the postoperative morbidity rates continue to be relatively high (20–50%) [1, 3–5, 8–10]. The most frequent causes of post-PD morbidity are development of pancreatic fistula (POPF), delayed gastric emptying (DGE),
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and post-pancreatectomy hemorrhage (PPH) [6, 8, 10–16]. In particular, PPH is often associated with POPF and is a life-threatening complication. The reported incidence of PPH after PD ranges from 3 to 10% [3–6, 8, 10, 14, 17–21]. Adequate PPH management is a key impe
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