Omental wrapping of skeletonized major vessels after pancreaticoduodenectomy

Occasionally, a pancreatic leakage results in a poor outcome. Even today, its rate of occurrence ranges from 2 to 13%. The purpose of this study is to describe the omental-wrapping technique and to evaluate its clinical utility for preventing serious complications following pancreatic leakage. The clinical records of 54 patients who underwent this technique were reviewed for their short-term outcome. After completing all reconstruction, an omental flap was spread out behind the pancreaticojejunostomy, allowing complete isolation of the skeletonized major vessels from the pancreatic anastomosis. There was no operative death or intra-abdominal bleeding. Pancreatic leakage occurred in 5 patients, all associated with bacterial infection. However, drains placed in the retroperitoneal space, which was isolated from the pancreatic anastomosis by the flap, were aseptic in all patients. The pancreatic leakage was closed with no additional serious conditions related to the leak. Our studies demonstrate that the omental wrapping technique is one of the useful surgical options for preventing serious conditions following a pancreatic leakage.