Wrapping in pancreatic surgery: a systematic review
Jose M Ramia1, Roberto de la Plaza, Farah Adel
1HPB Surgical Service, Department of Surgery, University Hospital of Guadalajara, Guadalajara, Spain.
ANZ Journal of Surgery
|February 28, 2015
Summary
Current evidence does not support using omentum or falciform ligament (FL) wrapping in pancreatic surgery. Further randomized studies are needed to determine if this technique should be widely adopted.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Abdominal Surgery
Background:
- Pancreatic surgery often employs omentum or falciform ligament (FL) wrapping for critical structures.
- The actual benefits of this wrapping technique remain unclear.
Purpose of the Study:
- To systematically review existing literature on the efficacy of wrapping in pancreatic surgery.
Main Methods:
- A comprehensive literature search was conducted in PubMed/MEDLINE from 1966 to 2012.
- Search terms included variations of 'wrapping', 'omentum', 'pancreas', 'pancreatoduodenectomy', and 'falciform ligament'.
Main Results:
- Twelve articles were selected for review.
- In studies with control groups, only one showed a significant reduction in pancreatic fistula (PF); others noted reduced post-operative hemorrhage.
- Series without control groups suggested a slight decrease in bleeding and PF rates.
Conclusions:
- The current literature does not provide sufficient evidence to recommend omentum/FL wrapping in pancreatic surgery.
- High-quality, prospective randomized trials are necessary to ascertain the generalizability of wrapping techniques.
