Routine Vascular Control Using the Nonabsorbable Polymer Ligating Clips in Open Pancreaticoduodenectomy-Early...

The purpose of this study was to evaluate the utility of the nonabsorbable polymer ligating clips during open pancreaticoduodenectomy. Ninety-eight consecutive patients underwent open pancreaticoduodenectomy using either the polymer clip (hem-o-lock R) system for gastroduodenal artery and right gastric artery control or conventional knot tying (n = 151) for these artery control. The two groups were similar regarding demographic data, preoperative/intraoperative characteristic, pathologic findings, anastomotic leakage, and intraperitoneal collections or abscess. There were no intraoperative complications. Overall, postpancreatectomy hemorrhage occurred in 26 patients (10.44 %) including 16 patients (6.4 %) with severe hemorrhage, for clip system group was 1 % (1 of 98), 8.6 % (13 of 151) for the conventional technique group (P = 0.011). Only one patient (1 %) of clip group required intervention treatment (vascular complications unassociated with ligation), with no death. For conventional ligation group, a total of 12 patients (7.9 %) underwent intervention treatment with two deaths. Eight of these patients were diagnosed with intraperitoneal hemorrhage from visceral artery pseudoaneurysms, which originated from the gastroduodenal artery in four patients, hepatic artery in one, common hepatic artery in two, and celiac trunk in one. Postoperative mortality was 1.6 % (4 of 249), all in the conventional group. The polymer clip technique is easy, safe, and effective for control of the gastroduodenal artery and right gastric artery in the open pancreaticoduodenectomy.