Preventive Effect of Omental Flap in Pancreaticoduodenectomy against Postoperative Pseudoaneurysm Formation

Matsuda, Hiroaki; Shinmoto, Hiroshi; Umeda, Yuzo; Shinoura, Susumu; Yoshida, Ryuichi; Satoh, Daisuke; Utsumi, Masashi; Yagi, T.; Fujiwara, Toshiyoshi

doi:10.5754/hge11452

Cited by 21 publications

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“…The role of pancreatic enzymes, infection and inflammatory mediators to the process that predisposes to bleeding remains undetermined. It has not been the routine practice at our institution to protect vessels, however, in the absence of routinely identifiable risk factors for a severe haemorrhage, the use of vascularized pedicle flaps to cover exposed vessels may be considered …”

Section: Discussionmentioning

confidence: 99%

Management of a delayed post pancreatoduodenectomy haemorrhage using endovascular techniques

Asai

Zaydfudim

Truty

et al. 2015

HPB

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Section: Discussionmentioning

confidence: 99%

Management of a delayed post pancreatoduodenectomy haemorrhage using endovascular techniques

Asai

Zaydfudim

Truty

et al. 2015

HPB

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“…A Braun anastomosis was also added. The details of these surgical techniques have been reported previously [10, 11]. In most cases, three drains were placed around the pancreatic and biliary anastomoses.…”

Section: Methodsmentioning

confidence: 99%

Radiographic sarcopenia predicts postoperative infectious complications in patients undergoing pancreaticoduodenectomy

et al. 2017

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BackgroundRecently, skeletal muscle depletion (sarcopenia) has been reported to influence postoperative outcomes after certain procedures. This study investigated the impact of sarcopenia on postoperative outcomes following pancreaticoduodenectomy (PD).MethodsWe performed a retrospective study of consecutive patients (n = 219) who underwent PD at our institution between January 2007 and May 2013. Sarcopenia was evaluated using preoperative computed tomography. We evaluated postoperative outcomes and the influence of sarcopenia on short-term outcomes, especially infectious complications. Subsequently, multivariate analysis was used to assess the impact of prognostic factors (including sarcopenia) on postoperative infections.ResultsThe mortality, major complication, and infectious complication rates for all patients were 1.4%, 16.4%, and 47.0%, respectively. Fifty-five patients met the criteria for sarcopenia. Sarcopenia was significantly associated with a higher incidence of in-hospital mortality (P = 0.004) and infectious complications (P < 0.001). In multivariate analyses, sarcopenia (odds ratio = 3.43; P < 0.001), preoperative biliary drainage (odds ratio = 2.20; P = 0.014), blood loss (odds ratio = 1.92; P = 0.048), and soft pancreatic texture (odds ratio = 3.71; P < 0.001) were independent predictors of postoperative infections.ConclusionsSarcopenia is an independent preoperative predictor of infectious complications after PD. Clinical assessment combined with sarcopenia may be helpful for understanding the risk of postoperative outcomes and determining perioperative management strategies.

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“…Various techniques have been suggested to reduce the chance of pseudoaneurysm formation, including the ‘wrapping’ technique, in which the exposed retroperitoneal vessels are covered with omentum or the falciform ligament. Others have suggested leaving 1 cm at the origin of the GDA stump to minimize the likelihood of lytic pancreatic juices coming into contact with the vessel.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the incidence, presentation and management of gastroduodenal artery pseudoaneurysm after pancreatic resection

Brodie

Kocher

2019

BJS Open

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BackgroundGastroduodenal artery (GDA) pseudoaneurysm is a serious complication following pancreatic resection, associated with high morbidity and mortality rates. This review aimed to report the incidence of GDA pseudoaneurysm after pancreatic surgery, and describe clinical presentation and management.MethodsMEDLINE and Embase were searched systematically for clinical studies evaluating postoperative GDA pseudoaneurysm. Incidence was calculated by dividing total number of GDA pseudoaneurysms by the total number of pancreatic operations. Additional qualitative data related to GDA pseudoaneurysm presentation and management following pancreatic resection were extracted and reviewed from individual reports.ResultsNine studies were selected for systematic review involving 4227 pancreatic operations with 55 GDA pseudoaneurysms, with a reported incidence of 1·3 (range 0·2–8·3) per cent. Additional data were extracted from 39 individual examples of GDA pseudoaneurysm from 14 studies. The median time for haemorrhage after surgery was at 15 (range 4–210) days. A preceding complication in the postoperative period was documented in four of 21 patients (67 per cent), and sentinel bleeding was observed in 14 of 20 patients (70 per cent). Postoperative complications after pseudoaneurysm management occurred in two‐thirds of the patients (14 of 21). The overall survival rate was 85 per cent (33 of 39).ConclusionGDA pseudoaneurysm is a rare yet serious cause of haemorrhage after pancreatic surgery, with high mortality. The majority of the patients had a preceding complication. Sentinel bleeding was an important clinical indicator.

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Preventive Effect of Omental Flap in Pancreaticoduodenectomy against Postoperative Pseudoaneurysm Formation

Abstract: Omental flap placement over splanchnic vessels could be a feasible and efficient surgical procedure to prevent postoperative pseudoaneurysms following pancreaticoduodenectomy.

Cited by 21 publications

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Management of a delayed post pancreatoduodenectomy haemorrhage using endovascular techniques

Management of a delayed post pancreatoduodenectomy haemorrhage using endovascular techniques

Radiographic sarcopenia predicts postoperative infectious complications in patients undergoing pancreaticoduodenectomy

Systematic review of the incidence, presentation and management of gastroduodenal artery pseudoaneurysm after pancreatic resection

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