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Omental Flap in Pancreaticoduodenectomy for Protection of Splanchnic Vessels

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Abstract

Intraabdominal bleeding, the most life-threatening complication following pancreaticoduodenectomy (PD), most often is associated with failure of a pancreaticojejunostomy anastomosis or with intraabdominal infection. We investigated whether placement of an omental flap around the splanchnic vessels in PD could reduce the occurrence of intraabdominal bleeding and other postoperative complications. One hundred consecutive patients who underwent PD at the authors’ institution between January 2000 and October 2004 were enrolled in this prospective study. After dissection of the hepatoduodenal ligament, the major splanchnic arteries and the portal vein were covered by the omental flap. Preoperative condition, incidence of pancreatic fistula, intra-abdominal bleeding, other complications, treatment mortality, and hospital stay were analyzed for interrelationships. The frequency of pancreatic fistula (20%) differed little from those in previous reports. However, intraabdominal bleeding was observed in only 1 (1.0%) patient, who was considered to have too thin a flap. No intraabdominal abscess was encountered. No mortality or complications occurred in relation to the omental flap. Thus, wrapping an omental flap around dissected splanchnic vessels in PD reduced postoperative intraabdominal bleeding and infection, but failed to prevent pancreatic fistulas.

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References

  1. Afsari A, Zhandoug Z, Young S, et al. Outcome analysis of pancreaticoduodenectomy at a community hospital. Am. Surg. 2002;68:281–284

    PubMed  Google Scholar 

  2. Conlon KC, Labow D, Leung D, et al. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann. Surg. 2001;234:487–493

    Article  PubMed  Google Scholar 

  3. Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann. Surg. 2000;232:786–795

    Article  PubMed  Google Scholar 

  4. Buchler MW, Friess H, Wagner M, et al. Pancreatic fistula after pancreatic head resection. Br. J. Surg. 2000;87:883–889

    Article  PubMed  Google Scholar 

  5. Povoski SP, Karpeh MS Jr, Conlon KC, et al. Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann. Surg. 1999;230:131–142

    Article  PubMed  Google Scholar 

  6. Roder JD, Stein HJ, Bottcher KA, et al. Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy: a prospective study. Ann. Surg. 1999;229:41–48

    Article  PubMed  Google Scholar 

  7. Sato N, Yamaguchi K, Chijiiwa K, et al. Risk analysis of pancreatic fistula after pancreatic head resection. Arch. Surg. 1998;133:1094–1098

    Article  PubMed  Google Scholar 

  8. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann. Surg. 1997;226:248–257

    Article  PubMed  Google Scholar 

  9. Marcus SG, Cohen H, Ranson JH. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann. Surg. 1995;221:635–645

    PubMed  Google Scholar 

  10. Cullen JJ, Sarr MG, Ilstrup DM. Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management. Am. J. Surg. 1994; 168:295–298

    PubMed  Google Scholar 

  11. Miedema BW, Sarr MG, van Heerden JA, et al. Complications following pancreaticoduodenectomy. Current management. Arch. Surg. 1992; 127:945–949

    PubMed  Google Scholar 

  12. Yeo CJ, Cameron JL, Sohn TA, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann. Surg. 1999;229:613–622

    Article  PubMed  Google Scholar 

  13. Yeo CJ, Cameron JL, Lillemoe KD, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann. Surg. 2000;232:419–429

    Article  PubMed  Google Scholar 

  14. Grobmyer SR, Rivadeneira DE, Goodman CA, et al. Pancreatic anastomotic failure after pancreaticoduodenectomy. Am. J. Surg. 2000;180:117–120

    Article  PubMed  Google Scholar 

  15. Nitecki SS, Sarr MG, Colby TV, et al. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann. Surg. 1995;221:59–66

    PubMed  Google Scholar 

  16. Yeo CJ, Cameron JL, Maher MM, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann. Surg. 1995;222:580–588

    PubMed  Google Scholar 

  17. Kakita A, Yoshida M, Takahashi T. History of pancreaticojejunostomy in pancreaticoduodenectomy: development of a more reliable anastomosis technique. J. Hepatobiliary Pancreat. Surg. 2001;8:230–237

    Article  PubMed  Google Scholar 

  18. Jones G, Jurkiewicz MJ, Bostwick J, et al. Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann. Surg. 1997;225:766–776

    Article  PubMed  Google Scholar 

  19. Losken A, Carlson GW, Culbertson JH, et al. Omental free flap reconstruction in complex head and neck deformities. Head Neck 2002;24:326–331

    Article  PubMed  Google Scholar 

  20. Hirai I, Murakami G, Kimura W, et al. Long descending lymphatic pathway from the pancreaticoduodenal region to the para-aortic nodes: its laterality and topographical relationship with the celiac plexus. Okajimas Folia Anat. Jpn. 2001;77:189–199

    PubMed  Google Scholar 

  21. Hirai I, Kimura W, Ozawa K, et al. Perineural invasion in pancreatic cancer. Pancreas 2002;24:15–25

    Article  PubMed  Google Scholar 

  22. Bhuiya MR, Nimura Y, Kamiya J, et al. Clinicopathologic studies on perineural invasion of bile duct carcinoma. Ann. Surg. 1992;215:344–349

    PubMed  Google Scholar 

  23. Sobin LH, Wittekind. International Union Against Cancer (UICC) TNM Classification of Malignant Tumours, 6th edition, New York, Wiley-Liss, 2002;87–96

    Google Scholar 

  24. Child CG III. Carcinoma of duodenum: one-stage radical pancreaticoduodenectonly preserving the external pancreatic secretion, case report. Ann. Surg. 1941;118:838–842

    Google Scholar 

  25. Rumstadt B, Schwab M, Korth P, et al. Hemorrhage after pancreatoduodenectomy. Ann. Surg. 1998;227:236–241

    Article  PubMed  Google Scholar 

  26. Yoshida T, Matsumoto T, Morii Y, et al. Delayed massive intraperitoneal hemorrhage after pancreatoduodenectomy. Int. Surg. 1998;83:131–135

    PubMed  Google Scholar 

  27. Trede M, Schwall G. The complications of pancreatectomy. Ann. Surg. 1988;207:39–47

    PubMed  Google Scholar 

  28. Shankar S, Russell RC. Haemorrhage in pancreatic disease. Br. J. Surg. 1989;76:863–866

    PubMed  Google Scholar 

  29. Patel AG, Toyama MT, Kusske AM, et al. Pylorus-preserving Whipple resection for pancreatic cancer. Is it any better? Arch. Surg. 1995;130:838–842

    PubMed  Google Scholar 

  30. Wade TP, el-Ghazzawy AG, Virgo KS, et al. The Whipple resection for cancer in U.S. Department of Veterans Affairs Hospitals. Ann. Surg. 1995;221:241–248

    PubMed  Google Scholar 

  31. Zerbi A, Balzano G, Patuzzo R, et al. Comparison between pylorus-preserving and Whipple pancreatoduodenectomy. Br. J. Surg. 1995;82:975–979

    PubMed  Google Scholar 

  32. Allema JH, Reinders ME, van Gulik TM, et al. Results of pancreaticoduodenectomy for ampullary carcinoma and analysis ofprognostic factors for survival. Surgery 1995;17:247–253

    Google Scholar 

  33. Sohn TA, Yeo CJ, Cameron JL, et al. Pancreaticoduodenectomy. Role of interventional radiologists in managing patients and complications. J. Gastrointest. Surg. 2003;7:209–219

    Article  PubMed  Google Scholar 

  34. Piano G, Massad MG, Amory DW Jr, et al. Omental transfer for salvage of the moribund lower extremity. Am. Surg. 1998;64:424–427

    PubMed  Google Scholar 

  35. Liebermann-Meffert D. The greater omentum. Anatomy, embryology, and surgical applications. Surg. Clin. North Am. 2000;80:275–293

    Article  PubMed  Google Scholar 

  36. Adams W, Ctercteko G, Bilous M. Effect of an omental wrap on the healing and vascularity of compromised intestinal anastomoses. Dis. Colon Rectum 1992;35:731–738

    Article  PubMed  Google Scholar 

  37. Merad F, Hay JM, Fingerhut A, et al. Omentoplasty in the prevention of anastomotic leakage after colonic or rectal resection: a prospective randomized study in 712 patients. French Associations for Surgical Research. Ann. Surg. 1998;227:179–186

    Article  PubMed  Google Scholar 

  38. Van Garderen JA, Wiggers T, van Geel AN. Complications of the pedicled omentoplasty. Neth. J. Surg. 1991;43:171–174

    PubMed  Google Scholar 

  39. Moriura S, Ikeda S, Ikezawa T, et al. The inclusion of an omental flap in pancreatoduodenectomy. Surg. Today 1994;24:940–941

    Article  PubMed  Google Scholar 

  40. Seyama Y, Kubota K, Kobayashi T, et al. Two-staged pancreatoduodenectomy with external drainage of pancreatic juice andomental graft technique. J. Am. Coll. Surg. 1998;187:103–105

    Article  PubMed  Google Scholar 

  41. Baker RJ, Fischer SK, Lilloemoe KL, et al. Mastery of Surgery, Baltimore, Lippincott Williams & Wilkins, 2001;1313

    Google Scholar 

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimo-Nagakubo, 411-8777, Sunto-Nagaizumi, Shizuoka, Japan

    Atsuyuki Maeda M.D., Tomoki Ebata M.D., Hideyuki Kanemoto M.D., Kazuya Matsunaga M.D., Etsuro Bando M.D., Shigeki Yamaguchi M.D. & Katsuhiko Uesaka M.D.

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  1. Atsuyuki Maeda M.D.
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  2. Tomoki Ebata M.D.
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  3. Hideyuki Kanemoto M.D.
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  4. Kazuya Matsunaga M.D.
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  5. Etsuro Bando M.D.
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  6. Shigeki Yamaguchi M.D.
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  7. Katsuhiko Uesaka M.D.
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Maeda, A., Ebata, T., Kanemoto, H. et al. Omental Flap in Pancreaticoduodenectomy for Protection of Splanchnic Vessels. World J. Surg. 29, 1122–1126 (2005). https://doi.org/10.1007/s00268-005-7900-3

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  • DOI: https://doi.org/10.1007/s00268-005-7900-3

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