Omental flaps in pancreaticoduodenectomy

Pancreaticoduodenectomy continues to have a high morbidity (40-50%). Major complications of pancreaticoduodenectomy include leaks from the pancreaticojejunostomy and an intra-abdominal bleed from the gastroduodenal artery stump. The omentum has been used for the prevention of anastomotic leaks.

The use of omental flaps to prevent a pancreaticojejunostomy leak and bleeding complications from a pancreaticojejunostomy leak after pancreaticoduodenectomy.

Seventy-seven patients who underwent a pancreaticoduodenectomy.

Pedicled flaps were made from the greater omentum. One omental flap was wrapped over the pancreaticojejunostomy (separating it from gastroduodenal artery stump) and the second omental flap was wrapped over the duodenojejunostomy.

Omental flaps were used in 25 patients (Group 1) and a pancreaticoduodenectomy was done without an omental flap in 52 patients (Group 2). None of the 25 patients had any complications related to the omental flap. A pancreaticojejunostomy leak occurred in 4/25 (16%) patients in Group 1 and in 11/52 (21%) patients in Group 2 (P=0.762). None of the pancreaticojejunostomy leaks in Group 1 was clinically significant. The pancreaticojejunostomy leaks in Group 2 were responsible for intra-abdominal bleeding in 2 patients (1 died) and for intra-abdominal abscess in 5 patients (1 died). Neither of the 2 (8%) deaths in Group 1 was related to a complication from pancreaticojejunostomy. There were 5 (10%) deaths in Group 2 (three following an intra-abdominal bleed, one due to bleeding from the gastrojejunostomy, and one due to sepsis following a pancreaticojejunostomy leak). Thus, there were four patients in Group 2 who died from a pancreaticojejunostomy leak and/or a major vascular bleed vs. none in Group 1 (P=0.298).

The use of omental flaps is a simple technique for decreasing the risk of major vascular complications related to pancreaticojejunostomy leak following pancreaticoduodenectomy.