A comparative study of omentum wrapping in pancreaticojejunostomy for reducing postoperative pancreatic fistula

doi:10.7504/CJPS.ISSN1005-2208.2016.11.17

Abstract：Objective To investigate the efficacy of the omentum wrapping technique in pancreaticojejunostomy on decreasing the incidence of pancreatic fistula after pancreaticoduodenectomy. Methods The clinical data of 225 patients underwent pancreaticoduodenectomy and pancreaticojejunostomy in single operation group from January 2009 to October 2015 in No.2 Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital Affiliated to the Second Military Medical University were analyzed retrospectively. Patients were divided into two groups,including group with omentum wrapping technique (n=125) and control group without it (n=100). After propensity score matching,the rates of pancreatic fistula were compared between the two groups,including group with omentum wrapping technique (n=64) and control group without it (n=64). Results All operations were completed successfully. The overall complication rate of all 225 patients was 62.7%(141/225). The reoperation rate was 2.7%(6/225). The mortality is 2.7%(6/225). The incidence of pancreatic fistula was 46.7%(105/225),including 61 cases of Class A,37 cases of Class B,and 7 cases of Class C. The incidence of bleeding was 11%(25/225). The incidence of DGE was 24.9%(56/225). The incidence of abdominal infection was 20.9%(47/225). Except the incidence of pancreatic fistula,there was no statistical difference between the two groups in the incidence of bleeding,DGE and abdominal infection(P>0.05). In the omentum wrapping group, no reoperation case occurred,and there were only 2 death cases. In the control group,there were 4 reoperation cases and 4 death cases. There was no significant difference between the two groups in those data(P=0.119, 0.680). In the PSM model,soft pancreas,pancreatic duct diameter and omentum wrapping were related to the postoperative pancreatic fistula in single factor analysis. In the multiple factors analysis,pancreatic duct diameter <3 mm and no omentum wrapping were independent risk factors for pancreatic fistula. Conclusion The omentum wrapping technique can decrease the rate of pancreatic fistula and it is worth applying in pancreaticojejunostomy.