title: CLIP method (preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery) reduces intraoperative bleeding during pancreaticoduodenectomy.
abstract: BACKGROUND
  No previous reports have prospectively discussed an operative approach to reducing intraoperative bleeding during pancreaticoduodenectomy (PD). We have established the preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery (IPDA) method (CLIP), which uses a preoperative three-dimensional computed tomographic (3D-CT) image to precisely detect the IPDA root intraoperatively and ligates the IPDA before the pancreas head is isolated. The aim of this study was to clarify whether the new operative approach reduces intraoperative bleeding compared with classical PD.
  
  
  METHODS
  Between October 2003 and May 2005, classical PD was performed (n = 48), and from June 2005 to September 2006, PD with the CLIP method was prospectively performed (n = 48) at Wakayama Medical University Hospital. The perioperative status of the patients in the two groups, including intraoperative bleeding, was compared.
  
  
  RESULTS
  Median intraoperative bleeding in patients with the CLIP method was significantly reduced compared with classical PD (867 ml versus 728 ml; p = 0.026). Moreover, operative time, red blood cell transfusion (units), and red blood cell transfusion in patients with the CLIP method were significantly reduced compared with classical PD (p = 0.033, 0.042, 0.014, respectively). There were no differences in length from the SMA to the IPDA root when the preoperative measurement by 3D-CT image (37.9 +/- 8.9 mm) and the intraoperative findings (38.0 +/- 8.8 mm) were compared (p = 0.6283).
  
  
  CONCLUSIONS
  The CLIP method is a useful and reliable operative technique for reducing intraoperative bleeding in PD.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Shinomi
authors.initials: S
authors.lastname: Ina
authors.forename: Seiko
authors.initials: S
authors.lastname: Hirono
authors.forename: Ryohei
authors.initials: R
authors.lastname: Nishioka
authors.forename: Motoki
authors.initials: M
authors.lastname: Miyazawa
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Shimamoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D004386:Duodenum / Q000098:blood supply; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008026:Ligation / Q000379:methods; D008297:Male; D010179:Pancreas / Q000098:blood supply; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D011300:Preoperative Care; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed