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The falciform/round ligament "flooring," an effective method to reduce life-threatening post-pancreatectomy
Théophile Guilbaud1, Cindy Faust2, Olivier Picaud1
1Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France.
Insights
The falciform/round ligament "flooring" technique effectively reduces life-threatening bleeding after pancreatic surgery. This method is recommended to prevent severe late post-pancreatectomy hemorrhage (PPH).
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Vascular Surgery
Background:
- Late post-pancreatectomy hemorrhage (PPH) is a severe complication following pancreatic surgery.
- Effective strategies are needed to prevent life-threatening PPH, particularly Grade C bleeding.
Purpose of the Study:
- To evaluate the efficacy of the
Main Methods:
- Retrospective review of patients undergoing pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) between 2013-2021.
- Comparison of outcomes between patients who underwent "flooring" with falciform/round ligament versus "no flooring" (omental flap).
- Analysis of complications including clinically relevant postoperative pancreatic fistula (CR-POPF), late PPH (Grade B and C), and 90-day mortality.
Main Results:
- The "flooring" method was associated with a lower rate of intensive care unit admission.
- Among patients with Grade B/C late PPH, the rate of life-threatening Grade C PPH was significantly lower in the "flooring" group (28.6%) compared to the "no flooring" group (82.6%).
- The "flooring" method was identified as the sole protective factor against Grade C late PPH.
Conclusions:
- The "flooring" technique using the falciform/round ligament is effective in reducing life-threatening Grade C late PPH after pancreatectomy.
- This surgical method should be considered to improve patient outcomes and minimize severe hemorrhage complications.
Purpose:
Late post-pancreatectomy hemorrhage (PPH) represents the most severe complication after pancreatic surgery. We have measured the efficacy of major vessels "flooring" with falciform/round ligament to prevent life-threatening grade C late PPH after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP).
Methods:
All consecutive patients who underwent PD and DP between 2013 and 2021 were retrospectively reviewed on a prospectively maintained database. The cohort was divided in two groups: "flooring" vs. "no flooring" method group. The "no flooring" group had omental flap interposition. Patient characteristics and operative and postoperative data including clinically relevant postoperative pancreatic fistula (CR-POPF), late PPH (grade B and C), and 90-day mortality were compared between the two groups.
Results:
Two hundred and forty patients underwent pancreatic resections, including 143 PD and 97 DP. The "flooring" method was performed in 61 patients (39 PD and 22 DP). No difference was found between the two groups concerning severe morbidity, CR-POPF, delayed PPH, and mortality rate. The rate of patients requiring postoperative intensive care unit was lower in the "flooring" than in the "no flooring" method group (11.5% vs. 25.1%, p = 0.030). Among patients with grade B/C late PPH (n = 30), the rate of life-threatening grade C late PPH was lower in the "flooring" than in the "no flooring" method group (28.6% (n = 2/7) vs. 82.6% (n = 19/24), p = 0.014). Risk factor analysis showed that the "flooring" method was the only protective factor against grade C late PPH occurrence (p = 0.013).
Conclusion:
The "flooring" method using the falciform/round ligament should be considered during pancreatectomies to reduce the occurrence of life-threatening grade C late PPH.
