Flooring the Major Vessels with Falciform Ligament to Prevent Post‐Pancreatectomy Hemorrhage

• DOI: 10.1007/s00268-020-05637-5
• Publication Date: 2020-06-12T15:03:42Z
• Authors: Kenjiro Okada; Yoshiaki Murakami; Kenichiro Uemura; Naru Kondo; Naoya Nakagawa; Shingo Seo; Hiroyuki Otsuka; Shinya Takahashi
• Keywords: Aged, 80 and over; Male; Ligaments; Middle Aged; Postoperative Hemorrhage; Pancreaticoduodenectomy; 3. Good health; Pancreatic Fistula; 03 medical and health sciences; Pancreatectomy; 0302 clinical medicine; Humans; Female; Aged; Retrospective Studies

AbstractBackgroundOne 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).MethodsThis 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.ResultsMorbidity 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.ConclusionsFalciform ligament flooring method may help decrease the incidence of PPH after PD.