A ligamentum teres hepatis and falciform ligament 'belt and braces' approach in laparoscopic pancreaticoduodenectomy using a modified Blumgart anastomosis to minimize severe pancreatic fistula and post-operative complications.

Surg Oncol

Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China. Electronic address:

Published: December 2024

AI Article Synopsis

  • A study was conducted to evaluate how using the ligamentum teres hepatis and falciform ligament, which wraps around the gastroduodenal artery (GDA), impacts complications after laparoscopic pancreaticoduodenectomy (LPD).
  • Patients were divided into two groups: one with the ligamentous flap wrapping the GDA stump (Group A) and another that utilized the flap for both GDA wrapping and reinforcing the posterior wall (Group B).
  • Group B showed fewer complications like clinically relevant post-operative pancreatic fistulas, shorter hospital stays, and less need for abdominal drainage, indicating that this technique enhances the safety and outcomes of LPD.*

Article Abstract

Background: To determine whether ligamentum teres hepatis and falciform ligament, wrapped around the gastroduodenal artery (GDA) and reinforced the posterior wall in pancreatojejunostomy (PJ), protects the GDA stump and other skeletal blood vessels from erosive hemorrhage and reduces the incidence of clinically relevant post-operative pancreatic fistula (CR-POPF) and post-operative complications after laparoscopic pancreaticoduodenectomy (LPD).

Methods: We reviewed patients undergone LPD between January 2019 and June 2023. Patients were divided into two groups according to whether the ligamentous flap had been used to wrap the GDA stump (Group A) or to reinforce the posterior wall in PJ, together with the GDA wrapping procedure (Group B). Peri-operative data were reviewed to determine the effectiveness of this approach in preventing CR-POPF, post-pancreatectomy hemorrhage (PPH), and other complications.

Results: We enrolled 272 patients (Group A, 154 patients; Group B, 118 patients). Group B patients had significantly fewer ≥ Grade II Clavien-Dindo classification morbidities and CR-POPFs (P < 0.05), and lower length of hospital stay (LOS) and abdominal drainage tube insertion times. Risk factor analysis indicated that main pancreatic duct dilation, the PJ reinforcement procedure, and soft pancreatic tissue were associated with ≥Grade II Clavien-Dindo morbidities and CR-POPF complications.

Conclusions: The ligamentous flap application in LPD provided shelter to GDA stump and other skeletal blood vessels under PJ from erosive digestive juices, reinforced the posterior wall in PJ, reduced the incidence of CR-POPF and ≥Grade II Clavien-Dindo classification morbidities. This simple procedure is effective for improving surgical safety of LPD.

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Source
http://dx.doi.org/10.1016/j.suronc.2024.102152DOI Listing

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