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BMC Surgery
Published in: BMC Surgery 1/2022

Open Access 01-12-2022 | Pancreaticojejunostomy | Research

Application analysis of omental flap isolation and modified pancreaticojejunostomy in pancreaticoduodenectomy (175 cases)

Authors: Shun Deng, Jianhong Luo, Yongzhong Ouyang, Jiangbo Xie, Zhuo He, Bo Huang, Fei Bai, Ke Xiao, Bin Yin, Jinfeng Wang, Biaoming Xu, Chaohui Zuo

Published in: BMC Surgery | Issue 1/2022

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Abstract

Background

To explore the application value of free omental wrapping and modified pancreaticojejunostomy in pancreaticoduodenectomy (PD).

Methods

The clinical data of 175 patients who underwent pancreaticoduodenectomy from January 2015 to December 2020 were retrospectively analysed. In total, 86 cases were divided into Group A (omental wrapping and modified pancreaticojejunostomy) and 89 cases were divided into Group B (control group). The incidences of postoperative pancreatic fistula and other complications were compared between the two groups, and univariate and multivariate logistic regression analyses were used to determine the potential risk factors for postoperative pancreatic fistula. Risk factors associated with postoperative overall survival were identified using Cox regression.

Results

The incidences of grade B/C pancreatic fistula, bile leakage, delayed bleeding, and reoperation in Group A were lower than those in Group B, and the differences were statistically significant (P < 0.05). Group A had an earlier drainage tube extubation time, earlier return to normal diet time and shorter postoperative hospital stay than the control group (P < 0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) inflammatory factors 1, 3 and 7 days after surgery also showed significant. Univariate and multivariate logistic regression analyses showed that a body mass index (BMI) ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap and modified pancreaticojejunostomy were independent risk factors for pancreatic fistula (P < 0.05). Cox regression analysis showed that age ≥ 65 years old, body mass index ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap isolation and modified pancreaticojejunostomy, and malignant postoperative pathology were independent risk factors associated with postoperative overall survival (P < 0.05).

Conclusions

Wrapping and isolating the modified pancreaticojejunostomy with free greater omentum can significantly reduce the incidence of postoperative pancreatic fistula and related complications, inhibit the development of inflammation, and favourably affect prognosis.
Literature
1.
Braga M, Capretti G, Pecorelli N, Balzano G, Doglioni C, Ariotti R, Di Carlo V. A prognostic score to predict major complications after pancreaticoduodenectomy. Ann Surg. 2011;254(5):702–7 (discussion 707–708).PubMed
2.
Panni RZ, Guerra J, Hawkins WG, Hall BL, Asbun HJ, Sanford DE. National pancreatic fistula rates after minimally invasive pancreaticoduodenectomy: a NSQIP analysis. J Am Coll Surg. 2019;229(2):192-199.e191.PubMed
3.
4.
Hackert T, Werner J, Büchler MW. Postoperative pancreatic fistula. Surg J R Coll Surg Edinb Irel. 2011;9(4):211–7.
5.
Chen JF, Xu SF, Zhao W, Tian YH, Gong L, Yuan WS, Dong JH. Diagnostic and therapeutic strategies to manage post-pancreaticoduodenectomy hemorrhage. World J Surg. 2015;39(2):509–15.PubMed
6.
Hirono S, Kawai M, Okada KI, Miyazawa M, Kitahata Y, Hayami S, Ueno M, Yamaue H. Modified blumgart mattress suture versus conventional interrupted suture in pancreaticojejunostomy during pancreaticoduodenectomy: randomized controlled trial. Ann Surg. 2019;269(2):243–51.PubMed
7.
Onopriev V, Manuilov A, Rogal M, Voskanyan S. Experience with end-to-loop pancreaticoenteroanastomosis in pancreaticoduodenectomy. Hepatogastroenterology. 2003;50(53):1650–4.PubMed
8.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.PubMed
9.
Chen JS, Liu G, Li TR, Chen JY, Xu QM, Guo YZ, Li M, Yang L. Pancreatic fistula after pancreaticoduodenectomy: Risk factors and preventive strategies. J Cancer Res Ther. 2019;15(4):857–63.PubMed
10.
Roberts KJ, Hodson J, Mehrzad H, Marudanayagam R, Sutcliffe RP, Muiesan P, Isaac J, Bramhall SR, Mirza DF. A preoperative predictive score of pancreatic fistula following pancreatoduodenectomy. HPB (Oxford). 2014;16(7):620–8.
11.
Zhou Y, Yu J, Wu L, Li B. Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy on occurrences of postoperative pancreatic fistula after pancreaticoduodenectomy. Asian J Surg. 2015;38(3):155–60.PubMed
12.
Ye R, Zhong W, Long X, Zhang L. Effect of modified Blumgart pancreaticojejunostomy on nutritional status in elderly patients after pancreaticoduodenectomy. Am J Transl Res. 2021;13(10):11643–52.PubMedPubMedCentral
13.
Liang H, Wu JG, Wang F, Chen BX, Zou ST, Wang C, Luo SW. Choice of operative method for pancreaticojejunostomy and a multivariable study of pancreatic leakage in pancreaticoduodenectomy. World J Gastrointest Surg. 2021;13(11):1405–13.PubMedPubMedCentral
14.
Seyama Y, Kubota K, Kobayashi T, Hirata Y, Itoh A, Makuuchi M. Two-staged pancreatoduodenectomy with external drainage of pancreatic juice and omental graft technique. J Am Coll Surg. 1998;187(1):103–5.PubMed
15.
16.
Bass GA, Seamon MJ, Schwab CW. A surgeon’s history of the omentum: from omens to patches to immunity. J Trauma Acute Care Surg. 2020;89(6):e161–6.PubMed
17.
Shah OJ, Bangri SA, Singh M, Lattoo RA, Bhat MY. Omental flaps reduces complications after pancreaticoduodenectomy. Hepatobiliary Pancreat Dis Int HBPD INT. 2015;14(3):313–9.PubMed
18.
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161(3):584–91.
19.
Antolovic D, Koch M, Galindo L, Wolff S, Music E, Kienle P, Schemmer P, Friess H, Schmidt J, Büchler MW, et al. Hepaticojejunostomy—analysis of risk factors for postoperative bile leaks and surgical complications. J Gastrointest Surg. 2007;11(5):555–61.PubMed
20.
Reid-Lombardo KM, Ramos-De la Medina A, Thomsen K, Harmsen WS, Farnell MB. Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J Gastrointest Surg. 2007;11(12):1704–11.PubMed
21.
Andrianello S, Marchegiani G, Malleo G, Pollini T, Bonamini D, Salvia R, Bassi C, Landoni L. Biliary fistula after pancreaticoduodenectomy: data from 1618 consecutive pancreaticoduodenectomies. HPB (Oxford). 2017;19(3):264–9.
22.
Ausania F, Landi F, Martínez-Pérez A, Fondevila C. A meta-analysis of randomized controlled trials comparing laparoscopic vs open pancreaticoduodenectomy. HPB (Oxford). 2019;21(12):1613–20.
23.
Chen H, Wang W, Ying X, Deng X, Peng C, Cheng D, Shen B. Predictive factors for postoperative pancreatitis after pancreaticoduodenectomy: a single-center retrospective analysis of 1465 patients. Pancreatology. 2020;20(2):211–6.PubMed
24.
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.PubMed
25.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8.PubMed
26.
Müller PC, Ruzza C, Kuemmerli C, Steinemann DC, Müller SA, Kessler U, Z’Graggen K. 4/5 Gastrectomy in patients undergoing pancreaticoduodenectomy reduces delayed gastric emptying. J Surg Res. 2020;249:180–5.PubMed
27.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999 Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97–132 (quiz 133–134; discussion 196).PubMed
28.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
29.
Mizrahi JD, Surana R, Valle JW, Shroff RT. Pancreatic cancer. Lancet (London, England). 2020;395(10242):2008–20.
30.
31.
Torphy RJ, Fujiwara Y, Schulick RD. Pancreatic cancer treatment: better, but a long way to go. Surg Today. 2020;50(10):1117–25.PubMedPubMedCentral
32.
Mirrielees JA, Weber SM, Abbott DE, Greenberg CC, Minter RM, Scarborough JE. Pancreatic fistula and delayed gastric emptying are the highest-impact complications after whipple. J Surg Res. 2020;250:80–7.PubMed
33.
Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1–14.PubMed
34.
Enestvedt CK, Diggs BS, Cassera MA, Hammill C, Hansen PD, Wolf RF. Complications nearly double the cost of care after pancreaticoduodenectomy. Am J Surg. 2012;204(3):332–8.PubMed
35.
Vollmer CM Jr, Sanchez N, Gondek S, McAuliffe J, Kent TS, Christein JD, Callery MP. A root-cause analysis of mortality following major pancreatectomy. J Gastrointest Surg. 2012;16(1):89–102 (discussion 102-103).PubMed
36.
Vallance AE, Young AL, Macutkiewicz C, Roberts KJ, Smith AM. Calculating the risk of a pancreatic fistula after a pancreaticoduodenectomy: a systematic review. HPB (Oxford). 2015;17(11):1040–8.
37.
Jiwani A, Chawla T. Risk factors of pancreatic fistula in distal pancreatectomy patients. Surg Res Pract. 2019;2019:4940508.PubMedPubMedCentral
38.
Yamamoto T, Satoi S, Yanagimoto H, Hirooka S, Yamaki S, Ryota H, Kotsuka M, Matsui Y, Kon M. Clinical effect of pancreaticojejunostomy with a long-internal stent during pancreaticoduodenectomy in patients with a main pancreatic duct of small diameter. Int J Surg (London, England). 2017;42:158–63.
39.
Kang JS, Han Y, Kim H, Kwon W, Kim SW, Jang JY. Prevention of pancreatic fistula using polyethylene glycolic acid mesh reinforcement around pancreatojejunostomy: the propensity score-matched analysis. J Hepatobiliary Pancreat Sci. 2017;24(3):169–75.PubMed
40.
Mazzaferro D, Song P, Massand S, Mirmanesh M, Jaiswal R, Pu LLQ. The omental free flap—a review of usage and physiology. J Reconstr Microsurg. 2018;34(3):151–69.PubMed
41.
Choi SB, Lee JS, Kim WB, Song TJ, Suh SO, Choi SY. Efficacy of the omental roll-up technique in pancreaticojejunostomy as a strategy to prevent pancreatic fistula after pancreaticoduodenectomy. Arch Surg (Chicago, Ill : 1960). 2012;147(2):145–50.
42.
Turrini O, Delpero JR. Omental flap for vessel coverage during pancreaticoduodenectomy: a modified technique. J Chir. 2009;146(6):545–8.
43.
Nong K, Zhang Y, Liu S, Yang Y, Sun D, Chen X. Analysis of pancreatic fistula risk in patients with laparoscopic pancreatoduodenectomy: what matters. J Int Med Res. 2020;48(7):300060520943422.PubMed
44.
Ke ZX, Xiong JX, Hu J, Chen HY, Li Q, Li YQ. Risk factors and management of postoperative pancreatic fistula following pancreaticoduodenectomy: single-center experience. Curr Med Sci. 2019;39(6):1009–18.PubMed
45.
Hartwig W, Werner J, Jäger D, Debus J, Büchler MW. Improvement of surgical results for pancreatic cancer. Lancet Oncol. 2013;14(11):e476–85.PubMed
46.
Paik KY, Oh JS, Kim EK. Amylase level after pancreaticoduodenectomy in predicting postoperative pancreatic fistula. Asian J Surg. 2021;44(4):636–40.PubMed
47.
Andreasi V, Partelli S, Crippa S, Balzano G, Tamburrino D, Muffatti F, Belfiori G, Cirocchi R, Falconi M. A systematic review and meta-analysis on the role of omental or falciform ligament wrapping during pancreaticoduodenectomy. HPB (Oxford). 2020;22(9):1227–39.
48.
Maeda A, Ebata T, Kanemoto H, Matsunaga K, Bando E, Yamaguchi S, Uesaka K. Omental flap in pancreaticoduodenectomy for protection of splanchnic vessels. World J Surg. 2005;29(9):1122–6.PubMed
49.
Lynch L, O’Shea D, Winter DC, Geoghegan J, Doherty DG, O’Farrelly C. Invariant NKT cells and CD1d(+) cells amass in human omentum and are depleted in patients with cancer and obesity. Eur J Immunol. 2009;39(7):1893–901.PubMed
50.
Yap PY, Hwang JS, Bong JJ. A modified technique of pancreaticogastrostomy with short internal stent: a single surgeon’s experience. Asian J Surg. 2018;41(3):250–6.PubMed
51.
Zhou J, Yang JR, Wang L, Ren JJ, Xiao R. Modified end-to-side pancreaticojejunostomy for reducing pancreatic fistula after pancreaticoduodenectomy: a surgeon’s experience. Asian J Surg. 2019;42(1):420–1.PubMed
52.
Wang D, Liu X, Wu H, Liu K, Zhou X, Liu J, Guo W, Zhang Z. Clinical evaluation of modified invaginated pancreaticojejunostomy for pancreaticoduodenectomy. World J Surg Oncol. 2020;18(1):75.PubMedPubMedCentral
53.
Ferencz S, Bíró Z, Vereczkei A, Kelemen D. Innovations in pancreatic anastomosis technique during pancreatoduodenectomies. Langenbecks Arch Surg. 2020;405(7):1039–44.PubMedPubMedCentral
54.
Suragul W, Rungsakulkij N, Vassanasiri W, Tangtawee P, Muangkaew P, Mingphruedhi S, Aeesoa S. Predictors of surgical site infection after pancreaticoduodenectomy. BMC Gastroenterol. 2020;20(1):201.PubMedPubMedCentral
55.
Fujii T, Kanda M, Nagai S, Suenaga M, Takami H, Yamada S, Sugimoto H, Nomoto S, Nakao A, Kodera Y. Excess weight adversely influences treatment length of postoperative pancreatic fistula: a retrospective study of 900 patients. Pancreas. 2015;44(6):971–6.PubMed
56.
57.
Tanaka K, Yamada S, Sonohara F, Takami H, Hayashi M, Kanda M, Kobayashi D, Tanaka C, Nakayama G, Koike M, et al. Pancreatic fat and body composition measurements by computed tomography are associated with pancreatic fistula after pancreatectomy. Ann Surg Oncol. 2021;28(1):530–8.PubMed
58.
Gaujoux S, Cortes A, Couvelard A, Noullet S, Clavel L, Rebours V, Lévy P, Sauvanet A, Ruszniewski P, Belghiti J. Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy. Surgery. 2010;148(1):15–23.PubMed
59.
Williamsson C, Stenvall K, Wennerblom J, Andersson R, Andersson B, Tingstedt B. Predictive factors for postoperative pancreatic fistula—a Swedish nationwide register-based study. World J Surg. 2020;44(12):4207–13.PubMedPubMedCentral
60.
Jin KM, Liu W, Wang K, Bao Q, Wang HW, Xing BC. The individualized selection of pancreaticoenteric anastomosis in pancreaticoduodenectomy. BMC Surg. 2020;20(1):140.PubMedPubMedCentral
61.
62.
Seykora TF, Ecker BL, McMillan MT, Maggino L, Beane JD, Fong ZV, Hollis RH, Jamieson NB, Javed AA, Kowalsky SJ, et al. The beneficial effects of minimizing blood loss in pancreatoduodenectomy. Ann Surg. 2019;270(1):147–57.PubMed
Metadata
Title
Application analysis of omental flap isolation and modified pancreaticojejunostomy in pancreaticoduodenectomy (175 cases)
Authors
Shun Deng
Jianhong Luo
Yongzhong Ouyang
Jiangbo Xie
Zhuo He
Bo Huang
Fei Bai
Ke Xiao
Bin Yin
Jinfeng Wang
Biaoming Xu
Chaohui Zuo
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-022-01552-9

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