title: Falciform ligament in pancreatoduodenectomy for protection of skeletonized and divided vessels.
abstract: OBJECTIVE
  Pancreatic fistula, which is one of the main causes of late postpancreatectomy hemorrhage (PPH), is a common complication of pancreatoduodenectomy (PD). It may erode the anastomosis site and vascular wall in its vicinity, resulting in pseudoaneurysm formation and/or the rupture of major vessels. To protect the vessels near the area for pancreaticojejunostomy from potential pancreatic fistula, we have adopted a surgical option by which such vessels are separated from the pancreaticojejunostomy using a pedicled falciform ligament. We reviewed 36 patients who underwent PD that included this option.
  
  
  METHODS
  After the PD was completed (before reconstructions), the pedicled falciform ligament was spread widely on the major vessels exposed during resection, and was fixed to the surrounding retroperitoneal connective tissue. These procedures enabled the complete separation of these vessels from the pancreaticojejunostomy.
  
  
  RESULTS
  The mobilization and placement of the falciform ligament in the space between the pancreaticojejunostomy and the major vessels were successfully carried out without any complications. Although ten (28%) patients developed pancreatic fistula and three (8%) developed intraabdominal infection, none of the patients developed late PPH.
  
  
  CONCLUSIONS
  The present surgical option is technically simple and easy, and may be an effective prophylactic measure against late PPH following PD.
authors.affiliation: Department of Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan. abenbtg@kyorin-u.ac.jp
authors.forename: Nobutsugu
authors.initials: N
authors.lastname: Abe
authors.forename: Masanori
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Osamu
authors.initials: O
authors.lastname: Yanagida
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Masaki
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mori
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Atomi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply; D010185:Pancreatic Fistula / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D016896:Treatment Outcome