OBJECTIVES: Postoperative pancreatic fistula (POPF) remains a significant source of morbidity after distal pancreatectomy (DP). We describe a technique for coverage of the pancreatic stump after DP using a pedicled falciform ligament flap with a low POPF rate. METHODS: A retrospective review of clinical, radiographic, and pathologic variables of patients undergoing open DP between November 2005 and August 2009 was performed. After standardized DP, the pancreatic stump was closed using a pedicled falciform ligament flap. Postoperative pancreatic fistula was defined using the International Study Group classification for pancreatic fistula definition. RESULTS: Twenty-three consecutive patients underwent open DP and splenectomy with closure of the pancreatic stump using a pedicled falciform ligament flap. Pancreatic transection and stump closure was performed in a uniform fashion in all patients. Eight patients (35%) had additional organs resected. Two patients (8.7%) developed grade C POPFs, which were successfully managed with percutaneous drain placement. No additional patients developed a POPF or abdominal abscess. The median length of stay was 5 days. There were no perioperative mortalities. CONCLUSIONS: We conclude that use of a pedicled falciform ligament flap for coverage of the pancreatic stump is associated with a low incidence of POPF. Continued investigation of this technique is warranted.
OBJECTIVES:Postoperative pancreatic fistula (POPF) remains a significant source of morbidity after distal pancreatectomy (DP). We describe a technique for coverage of the pancreatic stump after DP using a pedicled falciform ligament flap with a low POPF rate. METHODS: A retrospective review of clinical, radiographic, and pathologic variables of patients undergoing open DP between November 2005 and August 2009 was performed. After standardized DP, the pancreatic stump was closed using a pedicled falciform ligament flap. Postoperative pancreatic fistula was defined using the International Study Group classification for pancreatic fistula definition. RESULTS: Twenty-three consecutive patients underwent open DP and splenectomy with closure of the pancreatic stump using a pedicled falciform ligament flap. Pancreatic transection and stump closure was performed in a uniform fashion in all patients. Eight patients (35%) had additional organs resected. Two patients (8.7%) developed grade C POPFs, which were successfully managed with percutaneous drain placement. No additional patients developed a POPF or abdominal abscess. The median length of stay was 5 days. There were no perioperative mortalities. CONCLUSIONS: We conclude that use of a pedicled falciform ligament flap for coverage of the pancreatic stump is associated with a low incidence of POPF. Continued investigation of this technique is warranted.
Authors: Timothy I Carter; Zhi Ven Fong; Terry Hyslop; Harish Lavu; Wei Phin Tan; Jeffrey Hardacre; Patricia K Sauter; Eugene P Kennedy; Charles J Yeo; Ernest L Rosato Journal: J Gastrointest Surg Date: 2012-07-14 Impact factor: 3.452
Authors: Allison N Martin; Sowmya Narayanan; Florence E Turrentine; Todd W Bauer; Reid B Adams; Victor M Zaydfudim Journal: PLoS One Date: 2018-09-13 Impact factor: 3.240
Authors: T Vowinkel; F Becker; A S Mehdorn; A K Schwieters; W A Mardin; N Senninger; B Strücker; A Pascher Journal: Langenbecks Arch Surg Date: 2022-05-04 Impact factor: 2.895