Anaïs Palen1, Jonathan Garnier2, Jean-Robert Delpero2, Olivier Turrini3, Jacques Ewald2. 1. Department of Surgical Oncology, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France. palena@ipc.unicancer.fr. 2. Department of Surgical Oncology, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France. 3. Department of Surgical Oncology, Institut Paoli-Calmettes, CRCM, Aix-Marseille University, Marseille, France.
Abstract
PURPOSE: This study proposes and details a simple and inexpensive protective technique of wrapping the hepatic and gastroduodenal artery stumps with a peritoneal patch during pancreatoduodenectomy (PD) in order to decrease post-pancreatectomy hemorrhage (PPH). METHODS: Among the 85 patients who underwent PD between July 2020 and March 2021, 16 patients with high-risk pancreatic anastomosis received a peritoneal patch. The Updated Alternative Fistula Risk Score (ua-FRS) was calculated. Post-operative pancreatic fistula (POPF) and PPH were diagnosed and graded according to the International Study Group of Pancreatic Surgery. The mortality rate was calculated up to 90 days after PD. RESULTS: The mean ua-FRS of the 16 patients was 43% (range: 21-63%). Among them, 6 (38%) experienced clinically relevant-POPF, and a PPH was observed in two patients (13%). In these two patients who required re-intervention, the peritoneal patch was remarkably intact, and neither the gastroduodenal stump nor hepatic artery was involved. None of the patients experienced 90-day mortality. CONCLUSION: Although the outcomes are encouraging, the evaluation of a larger series to assess the effectiveness of the peritoneal protective patch for arteries in a high-risk pancreatic anastomosis is ongoing.
PURPOSE: This study proposes and details a simple and inexpensive protective technique of wrapping the hepatic and gastroduodenal artery stumps with a peritoneal patch during pancreatoduodenectomy (PD) in order to decrease post-pancreatectomy hemorrhage (PPH). METHODS: Among the 85 patients who underwent PD between July 2020 and March 2021, 16 patients with high-risk pancreatic anastomosis received a peritoneal patch. The Updated Alternative Fistula Risk Score (ua-FRS) was calculated. Post-operative pancreatic fistula (POPF) and PPH were diagnosed and graded according to the International Study Group of Pancreatic Surgery. The mortality rate was calculated up to 90 days after PD. RESULTS: The mean ua-FRS of the 16 patients was 43% (range: 21-63%). Among them, 6 (38%) experienced clinically relevant-POPF, and a PPH was observed in two patients (13%). In these two patients who required re-intervention, the peritoneal patch was remarkably intact, and neither the gastroduodenal stump nor hepatic artery was involved. None of the patients experienced 90-day mortality. CONCLUSION: Although the outcomes are encouraging, the evaluation of a larger series to assess the effectiveness of the peritoneal protective patch for arteries in a high-risk pancreatic anastomosis is ongoing.
Authors: A Floortje van Oosten; F Jasmijn Smits; Daniël A F van den Heuvel; Hjalmar C van Santvoort; I Quintus Molenaar Journal: HPB (Oxford) Date: 2019-04-06 Impact factor: 3.647
Authors: I Koukoutsis; R Bellagamba; G Morris-Stiff; S Wickremesekera; C Coldham; S J Wigmore; A D Mayer; D F Mirza; J A C Buckels; S R Bramhall Journal: Dig Surg Date: 2006-07-26 Impact factor: 2.588
Authors: F Jasmijn Smits; Hjalmar C van Santvoort; Marc G Besselink; Marilot C T Batenburg; Robbert A E Slooff; Djamila Boerma; Olivier R Busch; Peter P L O Coene; Ronald M van Dam; David P J van Dijk; Casper H J van Eijck; Sebastiaan Festen; Erwin van der Harst; Ignace H J T de Hingh; Koert P de Jong; Johanna A M G Tol; Inne H M Borel Rinkes; I Quintus Molenaar Journal: JAMA Surg Date: 2017-06-01 Impact factor: 14.766
Authors: Brett L Ecker; Matthew T McMillan; Horacio J Asbun; Chad G Ball; Claudio Bassi; Joal D Beane; Stephen W Behrman; Adam C Berger; Euan J Dickson; Mark Bloomston; Mark P Callery; John D Christein; Elijah Dixon; Jeffrey A Drebin; Carlos Fernandez-Del Castillo; William E Fisher; Zhi Ven Fong; Ericka Haverick; Robert H Hollis; Michael G House; Steven J Hughes; Nigel B Jamieson; Ammar A Javed; Tara S Kent; Stacy J Kowalsky; John W Kunstman; Giuseppe Malleo; Katherine E Poruk; Ronald R Salem; Carl R Schmidt; Kevin Soares; John A Stauffer; Vicente Valero; Lavanniya K P Velu; Amarra A Watkins; Christopher L Wolfgang; Amer H Zureikat; Charles M Vollmer Journal: Ann Surg Date: 2018-04 Impact factor: 12.969
Authors: Moritz N Wente; Johannes A Veit; Claudio Bassi; Christos Dervenis; Abe Fingerhut; Dirk J Gouma; Jakob R Izbicki; John P Neoptolemos; Robert T Padbury; Michael G Sarr; Charles J Yeo; Markus W Büchler Journal: Surgery Date: 2007-07 Impact factor: 3.982
Authors: Timothy H Mungroop; Sjors Klompmaker; Ulrich F Wellner; Ewout W Steyerberg; Andrea Coratti; Mathieu D'Hondt; Matteo de Pastena; Safi Dokmak; Igor Khatkov; Olivier Saint-Marc; Uwe Wittel; Mohammed Abu Hilal; David Fuks; Ignasi Poves; Tobias Keck; Ugo Boggi; Marc G Besselink Journal: Ann Surg Date: 2021-02-01 Impact factor: 13.787