Embedment of the gastroduodenal artery stump into the jejunal serosa: A new technique aiming to prevent post-pancreatectomy hemorrhage

Main Article Content

Serafeim Klimopoulos
Alexandra Charakopoulou
Athanasios Pantelis
Konstantinos Bouchagier https://orcid.org/0000-0002-3291-3619

Keywords

pancreatic cancer, pancreaticoduodenectomy, post-pancreatectomy hemorrhage, gastroduodenal artery, pseudoaneurysm

Abstract

Post-pancreaticoduodenectomy hemorrhage has an estimated incidence of 5% and a mortality rate of 11–38%. Vascular erosion resulting from pancreatic leak and skeletonization of the arterial wall during pancreatic mobilization may be the two possible mechanisms responsible for this complication, which most commonly affects the gastroduodenal artery stump. A novel technique of wrapping up the gastroduodenal artery stump into the jejunal serosa to decrease postoperative hemorrhage is presented.
Abstract 335 | PDF Downloads 182 HTML Downloads 11 XML Downloads 4

References

1. Cameron JL, Pitt HA, Yeo CJ, et al. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993;217(5):430–8. https://doi.org/10.1097/ 00000658-199305010-00002

2. Miedema BW, Sar MG, van Heerden JA, et al. Complications following pancreaticoduodenectomy. Current management. Arch Surg 1992; 127(8):945–9. https://doi.org/10.1001/archsurg. 1992.01420080079012

3. Cameron JL, Riall TS, Coleman J, et al. One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006;244:10–15. https://doi.org/10.1097/01. sla.0000217673.04165.ea

4. Miura F, Asano T, Amano H, et al. Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleed-ing: re-laparotomy or interventional radiology. J  Hepatobiliary Pancreat Surg 2009;16:56–63. https://doi.org/10.1007/s00534-008-0012-3

5. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007;142:20–5. https:// doi.org/10.1016/j.surg.2007.02.001

6. Roulin D, Cerantola Y, Demartines N, Schafer M. Systematic review of delayed postoperative hemorrhage after pancreatic resection. J Gastrointest Surg 2011;15(6):1055–62. https://doi.org/10.1007/ s11605-011-1427-8

7. Pang TCY, Maher R, Gananadha S, Hugh TJ, Samra JS. Peripancreatic pseudoaneurysms: a management-based classification system. Surg Endosc 2014;28(7):2027–38. https://doi.org/10.1007/s00464-014-3434-9

8. Kapoor VK, Sharma A, Behari A, Singh RK. Omental flaps in pancreaticoduodenectomy. J Pancreas 2006;7(6):608–15.

9. Kapoor VK, Gupta N, Behari A, et al. Omental flap to protect gastro-duodenal artery stump from  pancreatic anastomotic leak in pancreatoduodenectomy. J Pancreas 2016;17(3):289–93.

10. Sakamoto Y, Shimada K, Esaki M, Kajiwara T, Sano T, Kosuge T. Wrapping the stump of the gastroduodenal artery using the falciform ligament during pancreaticoduodenectomy. J Am Coll Surg 2007;204(2):334–6. https://doi.org/ 10.1016/j.jamcollsurg.2006.11.015

11. Müssle B, Wierick A, Distler M, Weitz J, Welsch T. Falciform ligament wrap for prevention of gastroduodenal artery bleed after pancreatoduodenectomy. J Surg Res 2017;207:215–22. https://doi. org/10.1016/j.jss.2016.08.087

12. Iannitti DA, Coburn NG, Somberg J, Ryder BA, Monchik J, Cioffi WG. Use of the round ligament of the liver to decrease pancreatic fistulas: a novel technique. J Am Coll Surg 2006;203:857–64. https://doi.org/10.1016/j.jamcollsurg.2006.08.021

13. Tani M, Kawai M, Hirono S, et al. Use of omen-tum or falciform ligament does not decrease complications after pancreaticoduodenectomy: nationwide survey of the Japanese Society of Pancreatic Surgery. Surgery 2012;151:183–9. https://doi.org/10.1016/j.surg.2011.07.023

14. Maeda A, Ebata T, Kanemoto H, et al. Omental flap in pancreaticoduodenectomy for protection of splanchnic vessels. Word J Surg 2005;29:1122–6. https://doi.org/10.1007/s00268-005-7900-3