Regional vessels wrapping following pancreaticoduodenectomy reduces the risk of post-operative extra-luminal bleeding. A systematic review

Hussameldin M Nour; Dimitra V Peristeri; Amiya Ahsan; Shehram Shafique; Prof Mansoor Khan; Muhammad S Sajid

doi:10.1016/j.amsu.2022.104618

Regional vessels wrapping following pancreaticoduodenectomy reduces the risk of post-operative extra-luminal bleeding. A systematic review

Ann Med Surg (Lond). 2022 Sep 14:82:104618. doi: 10.1016/j.amsu.2022.104618. eCollection 2022 Oct.

Authors

Hussameldin M Nour¹, Dimitra V Peristeri¹, Amiya Ahsan¹, Shehram Shafique², Prof Mansoor Khan¹, Muhammad S Sajid¹

Affiliations

¹ Department of Digestive Disease and General Surgery, Royal Sussex County Hospital, UHSussex NHS Trust, Eastern Road Brighton BN2 5BE, UK.
² Warwick Medical School, Medical School Building, Clifford Bridge Rd, Coventry, CV4 7HL, UK.

Abstract

Background: Post-pancreatectomy bleeding is a potentially fatal complication which results from the erosion of the regional visceral arteries, mainly the hepatic artery and stump of the gastro-duodenal artery, caused by a leak or fistula from the pancreatic anastomosis. The objective of this article is to assess whether wrapping of regional vessels with omentum or falciform/teres ligament following pancreaticoduodenectomy reduces the risk of extra-luminal bleeding.

Materials and method: Standard medical electronic databases were searched with the help of a local librarian and relevant published randomised controlled trials (RCT) and any type of comparative trial were shortlisted according to the inclusion criteria. The summated outcome of post-operative extra-luminal bleeding in patients undergoing pancreaticoduodenectomy was evaluated using the principles of meta-analysis on RevMan 5 statistical software.

Result: Two RCTs and 5 retrospective studies on 4100 patients undergoing pancreaticoduodenectomy were found suitable for this meta-analysis. There were 1404 patients in the wrapping-group (WG) and 2696 patients in the no-wrapping group (NWG). In the random effects model analysis, the incidence of extra-luminal haemorrhage was statistically lower in WG [odds ratio 0.51, 95%, CI (0.31, 0.85), Z = 2.59, P = 0.01]. There was moderate heterogeneity between the studies; however it was not statistically significant.

Conclusion: The wrapping of regional vessels (using omentum, falciform ligament or ligamentum teres) following pancreaticoduodenectomy seems to reduce the risk of post-operative extra-luminal bleeding. However, more RCTs of robust quality recruiting a greater number of patients are required to validate these findings as this study presents the combined data of two RCTs and 5 retrospective studies.

Keywords: Pancreatic neoplasm; Pancreatoduodenectomy; Post-pancreatoduodenectomy haemorrhage; Whipple; Wrapping.

Publication types

Review