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Superior perianastomotic fluid collection in the early postoperative period affects pseudoaneurysm occurrence after pancreaticoduodenectomy

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Abstract

Purpose

Pseudoaneurysm (PA) after pancreaticoduodenectomy (PD) is a harmful complication due to postoperative pancreatic fistula. However, the preventive method for PA is unclear. This study aimed to assess the risk factors for PA after PD and to evaluate the clinical features of patients with PA.

Methods

Medical records of 54 patients who underwent PD and developed clinically relevant postoperative pancreatic fistula (POPF) were retrospectively reviewed. We evaluated postoperative computed tomography (CT) findings, including the perianastomotic fluid collection (PFC) location on postoperative day 4. Perioperative findings and postoperative CT findings were compared between patients with and without PA after PD.

Results

The PA group included nine patients (17%). The median postoperative day of diagnosis of PA was 17 (range, 7–33). The PA locations were the gastroduodenal artery stump (n = 3), dorsal pancreatic artery (DPA) stump from the common hepatic artery (n = 4), DPA stump from the replaced right hepatic artery (n = 1), and inferior pancreaticoduodenal artery stump (n = 1). The prevalence of falciform ligament wrap to the hepatic artery was lower (33% vs. 78%, p = 0.014) and superior PFC prevalence was higher (100% vs. 58%, p = 0.019) in the PA group than in the non-PA group. Superior PFC reached the dorsal part of the caudate lobe of the liver in all patients with PA. Furthermore, all PAs occurred at the arteries that could not be wrapped by the falciform ligament.

Conclusion

Prevention of superior PFC and falciform ligament wrapping may reduce PA occurrence after PD with clinically relevant POPF.

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Authors and Affiliations

  1. Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan

    Hiromitsu Maehira, Hiroya Iida, Haruki Mori, Daiki Yasukawa, Takeru Maekawa, Keiji Muramoto, Katsushi Takebayashi, Sachiko Kaida, Toru Miyake & Masaji Tani

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  1. Hiromitsu Maehira
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  2. Hiroya Iida
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  10. Masaji Tani
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Contributions

Study conception and design: H. Maehira described and designed the manuscript. Acquisition of data: H. Maehira and H. Mori reviewed the computed tomography findings. H. Maehira performed the data analysis and interpretation. D. Yasukawa, T. Maekawa, K. Muramoto, K. Takebayashi, S. Kaida, and T. Miyake performed the surgery and postoperative management. Analysis and interpretation of data: H. Maehira. Drafting of manuscript: H. Maehira. Critical revision of manuscript: M. Tani and H. Iida revised the manuscript. All the authors have approved the final manuscript.

Corresponding author

Correspondence to Hiromitsu Maehira.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (ethics committee of Shiga University of Medical Science (registration number 29-170)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Maehira, H., Iida, H., Mori, H. et al. Superior perianastomotic fluid collection in the early postoperative period affects pseudoaneurysm occurrence after pancreaticoduodenectomy. Langenbecks Arch Surg 406, 1461–1468 (2021). https://doi.org/10.1007/s00423-020-02072-x

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