Retromesenteric Omental Flap as Arterial Coverage in Pancreaticoduodenectomy: A Novel Technique to Prevent Post-pancreatectomy Hemorrhage

Marique, Lancelot;Codjia, Tatiana;Dokmak, Safi;Aussilhou, Beatrice;Sauvanet, Alain;et.al.
(2023) 15th Biennial Congress of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) — Location: (France) Lyon (6.June.2023)

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  • Marique, LancelotUCLouvain
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  • Codjia, Tatiana
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  • Dokmak, Safi
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  • Aussilhou, Beatrice
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  • Sauvanet, Alain
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Abstract
Background: Post-pancreatectomy hemorrhage (PPH) occurs in 10-15% of patients following pancreaticoduodenectomy (PD), mainly in association with clinically relevant postoperative pancreatic fistula (CR-POPF). Prevention of PPH by arterial coverage (AC) with a round ligament plasty or an omental flap is controversial. This study evaluated clinically relevant PPH (CR-PPH) rate following AC with an original retromesenteric omental flap (ROF) in patients undergoing PD. Methods: This single center retrospective study included 812 open PD (2012-2021) and compared 146 procedures with AC using a ROF (AC-ROF) to 666 PD without AC (no AC). The Fistula Risk Score (FRS; Callery et al., J Am Coll Surg 2013) was calculated. CR-POPF and CR-PPH were recorded according to the ISGPS classification. Results: There were more patients with a high FRS (7-10) in the AC-ROF group: 18 (12%) vs. 48 (7%) with no AC (p<0.01). CR-POPF ocurred in 28 (19%) in the AC-ROF group versus 165 (25%), respectively (p=0.001). CR-PPH was less frequent in the AC-ROF group 5 (3%) versus 66 (10%) with no AC, respectively (p=0.01). There was no reoperations for PPH or POPF in the AC-ROF versus 25 (4%) with no AC (p=0.02). In the 65 patients (8% of the overall population) with FRS=7-10, the CR-PPH rate was 1/20 (5%) in the AC-ROF group vs. 7/45 (16%) in the no AC groupé (p=0.23). Conclusions: AC with ROF can reduce rates of CR-PPH following PD especially in patients at high risk for POPF. This simple and cost-free technique should be further evaluated to confirm these results.
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Marique, L., Codjia, T., Dokmak, S., Aussilhou, B., Jehaes, F., Bouquot, M., Cauchy, F., Lesurtel, M., & Sauvanet, A. (2023). Retromesenteric Omental Flap as Arterial Coverage in Pancreaticoduodenectomy: A Novel Technique to Prevent Post-pancreatectomy Hemorrhage. HPB : the official journal of the International Hepato Pancreato Biliary Association, 25(Suppl 2), S456-S457. https://doi.org/10.1016/j.hpb.2023.07.551 (Original work published 2023)