Prophylactic Omentopexy to Prevent Proximal Duodenal Staple Line Leak in Whole Organ Pancreas Transplantation

Enteric leaks following pancreas transplant cause significant morbidity and may result in allograft loss. The proximal duodenal staple line is particularly susceptible. We describe a novel technique utilizing omentopexy to mitigate proximal duodenal staple line leaks. This was a single center, retrospective analysis of all pancreas transplants performed from 10/01/2014-7/31/2024. The omentopexy technique was introduced in 10/2019. A piece of donor omentum is mobilized and retained during procurement, then used to buttress the proximal duodenal staple line after implantation. Recipients were identified as concerning for leak if they underwent percutaneous drainage or reoperation for peripancreatic fluid collections, and those with leaks as intraoperative confirmation or radiographic evidence of fistula to the donor duodenum. In total, 263 pancreas transplants were included - 155 prior to (pre) and 108 following (post) implementation of the omentopexy technique. Potential proximal duodenal leak was identified in 16(10.3%) pre versus 7(6.5%) post introduction, with confirmed proximal duodenal leaks in 7(4.5%) pre versus 1(0.9%) post. Management of leaks was with percutaneous drainage for 5 and operative intervention for 3 recipients. Omentopexy to the donor duodenal staple line is simple to perform and reduced the relative risk of proximal duodenal staple line leak by 78.7%.