Falciform ligament wrap for prevention of gastroduodenal artery bleed after pancreatoduodenectomy

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• 作者：Benjamin Mü ; ssle ; MD ; Ann Wierick ; MD ; Marius Distler ; MD ; Jü ; rgen Weitz ; MD ; Thilo Welsch ; MD ; ^{thilo.welsch@uniklinikum-dresden.de}
• 关键词：Falciform ligament ; Round ligament ; Pancreatoduodenectomy ; Pancreatic fistula ; Bleeding ; Gastroduodenal artery
• 刊名：Journal of Surgical Research
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：207
• 期：Complete
• 页码：215-222
• 全文大小：877 K
• 卷排序：207

文摘

The present study aims to assess the effectiveness and current evidence of a pedicled falciform ligament wrap around the gastroduodenal artery stump for prevention of erosion hemorrhage after pancreatoduodenectomy (PD).MethodsRetrospective data were pooled for meta-analysis. At the own center, patients who underwent PD between 2012 and 2015 were retrospectively analyzed based on the intraoperative performance of the wrap. A systematic literature review and meta-analysis was performed that combined the published and the obtained original data. The following databases were searched: Medline, Embase, Web of Science, and the Cochrane Library.ResultsAt the own center, a falciform ligament wrap was performed in 39 of 196 PDs (20%). The wrap group contained more ampullary neoplasms, but the pancreatic fistula rate was not significantly different from the nonwrap group (28% versus 32%). In median, erosion hemorrhage occurred after 21.5 d, and it was lethal in 39% of the patients. Its incidence was not significantly lower in the wrap group (incidence: 7.7% versus 9.6% in the nonwrap group). The systematic literature search yielded four retrospective studies with a high risk of bias; only one study was controlled. When the five data sets of published and own cases with a falciform ligament wrap were pooled, the incidence of erosion hemorrhage was 5 of 533 cases (0.9%) compared with 24 of 297 cases (8.1%) without the wrap.ConclusionsThe reported incidence of erosion hemorrhage after the falciform ligament wrap is low, but there are still insufficient controlled data to support its general use.