[Omental flap for vessel coverage during pancreaticoduodenectomy: a modified technique].
BACKGROUND
In 1994, a technique of omental flap development and interposition to cover the celiac and mesenteric vessels was described. Its aim was to isolate the pancreatic anastomosis from the vessels dissected during pancreaticoduodenectomy (PD) and thereby to reduce the consequences of postoperative pancreatic fistula - particularly the risk of postoperative bleeding.


METHODS
We describe this technique adding a simple modification consisting of passage of the pancreatic remnant through an omental window before completion of the pancreaticodigestive anastomosis.


RESULTS
Sixty-four patients underwent PD using an omental flap to cover the celiomesenteric vessels. No postoperative deaths occurred. The rate of PF was 23% and the rate of postoperative hemorrhage was 3% (two patients). No complications related to the omental flap were observed. All postoperative hemorrhages originated from the transected surface of the pancreatic remnant and were successfully treated by transgastrotomy simple suture.


CONCLUSIONS
This simple technique has no specific morbidity; it isolates the celiac and mesenteric vessels from the pancreatic anastomosis and therefore may reduce the risk of severe postoperative bleeding after PD.
Turrini
O
O
Département de chirurgie oncologique, institut Paoli-Calmettes, université de la Méditerranée, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France. oturrini@yahoo.fr
Delpero
J R
JR
D002445:Celiac Artery / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods; D006801:Humans; D008642:Mesenteric Veins / Q000601:surgery; D008643:Mesentery / Q000601:surgery; D009852:Omentum / Q000637:transplantation*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome