WE2.10 Regional vessels wrapping following pancreaticoduodenectomy reduce the risk of post-operative extra-luminal bleeding. A systematic review

Abstract

Abstract Aim Post-pancreatectomy bleeding which may be a potentially fatal complication, usually resulting from the erosion of the regional visceral arteries mainly the hepatic artery and stump of the gastro-duodenal artery, caused by a leak or fistula from the pancreatic anastomosis. The objective of this article is to assess whether regional vessels wrapping omentum or falciform/teres ligament following pancreaticoduodenectomy reduce the risk of post-operative extra-luminal bleeding. Method Standard medical electronic databases were searched with the help of local librarian and relevant published randomized controlled trial (RCT) and any type of comparative trials were shortlisted according to the inclusion criteria. Summated outcome of post-operative extra-luminal bleeding in patients undergoing pancreaticoduodenectomy was evaluated using the principles of meta-analysis on RevMan 5 statistical software. Result One RCT and 6 retrospective trials on 4100 patients undergoing pancreaticoduodenectomy for any indication were found suitable for this met-analysis. There were 1404 patients in the wrap-group (WG) group and 2696 patients in the no-wrap group (NWG). In the random effects model analysis, the incidence of extra-luminal hemorrhage rate was statistically lower in WG [odd ratio 0.51, 95%, CI (0.31, 0.85), Z=2.59, P=0.01]. There was moderate heterogeneity between the studies; however it was not statistically significant. Conclusion The wrapping of regional vessels (using omentum, falciform ligament or ligamentum teres following pancreaticoduodenectomy seems to reduce the risk of post-operative extra-luminal bleeding. However, more RCTs of robust quality recruiting higher number of patients are required to validate these findings because current study presented combined data of one RCT and 6 retrospective studies.