Use of the round ligament of the liver to decrease pancreatic fistulas: a novel technique

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Oncology

Background:

• Pancreatic anastomosis fistula rates after resection range from 2% to 27%.
• Vascular pedicle reinforcement is hypothesized to decrease fistula incidence.
• A novel technique using the round ligament of the liver is presented.

Purpose of the Study:

• To evaluate the efficacy of using the round ligament of the liver as a vascular pedicle to reinforce pancreatic anastomosis.
• To reduce the incidence of pancreatic fistulas following pancreatic resection.

Main Methods:

• Retrospective cohort study of 95 patients undergoing pancreatic resection (2000-2005).
• The round ligament of the liver was mobilized and sutured to reinforce the pancreatic anastomosis.
• Pancreatic fistula defined by drainage, reexploration, pseudocyst, or sepsis-related death.

Main Results:

• Overall fistula rate was 5.3% (5/95); 8.8% for pancreaticoduodenectomy (5/57).
• No fistulas occurred in distal pancreatectomy or enucleation groups (n=38).
• Zero mortality from pancreatic fistula and no operative interventions required.

Conclusions:

• Reinforcing pancreatic anastomosis with the round ligament as a vascular pedicle is a novel technique.
• This method appears to result in a very low pancreatic fistula rate.
• Further randomized trials are needed to confirm efficacy.