Use of omentum or falciform ligament does not decrease complications after pancreaticoduodenectomy: Nationwide survey of the Japanese Society of Pancreatic Surgery

• Published in: Surgery 2012-02, Vol.151 (2), p.183-191
• Main Authors: Tani, Masaji, MD, Kawai, Manabu, MD, Hirono, Seiko, MD, Hatori, Takashi, MD, Imaizumi, Toshihide, MD, Nakao, Akimasa, MD, Egawa, Shinichi, MD, Asano, Takehide, MD, Nagakawa, Takukazu, MD, Yamaue, Hiroki, MD
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Data Collection; Female; General aspects; Humans; Incidence; Japan; Ligaments - surgery; Male; Medical sciences; Middle Aged; Miscellaneous; Multivariate Analysis; Omentum - surgery; Pancreatic Fistula - epidemiology; Pancreatic Fistula - prevention & control; Pancreaticoduodenectomy - methods; Postoperative Hemorrhage - epidemiology; Postoperative Hemorrhage - prevention & control; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Factors; Societies, Medical; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2011.07.023

Background Wrapping is thought to prevent pancreatic fistula and postoperative hemorrhage for pancreaticoduodenectomy (PD), and we analyzed whether omentum/falciform ligament wrapping decreases postoperative complications after PD. Methods This is a retrospective study of wrapping using the omentum/falciform ligament in patients that underwent PD between January 2006 and June 2008 in 139 institutions that were members of the Japanese Society of Pancreatic Surgery. Results Ninety-one institutions responded to the questionnaires, and data were accumulated from 3,288 patients. The data from 2,597 patients were acceptable for analysis; 918 (35.3%) patients underwent wrapping and 1,679 patients did not. A pancreatic fistula occurred in 623 patients (37.3%) in the nonwrapping group, in comparison to 393 patients (42.8%) in the wrapping group ( P = .006). The incidence of a grade B/C pancreatic fistula was lower in the nonwrapping group than the wrapping group (16.7% vs 21.5%; P = .002). An intra-abdominal hemorrhage occurred in 54 patients (3.2%) in the nonwrapping group, which was similar to the incidence in the wrapping group (32 patients; 3.5%). The mortality was 1.3% and 1.0% in nonwrapping and wrapping groups, respectively. A multivariate analysis revealed 7 independent risk factors for pancreatic fistula; male, hypoalbuminemia, soft pancreas, long operation time, extended resection, pylorus preservation, and omentum wrapping. There were 4 independent risk factors for early intra-abdominal hemorrhage and 2 independent risk factors for late intra-abdominal hemorrhage. Conclusion This retrospective study revealed that omentum wrapping did not decrease the incidence of pancreatic fistula. An additional validation study is necessary to evaluate the efficacy of wrapping for PD.