Pancreatoduodenectomy with or without early ligation of the inferior pancreatoduodenal artery: comparison of intraoperative blood loss and short-term outcome.
BACKGROUND
Some of the significant predictive risk factors for complications after pancreatoduodenectomy are increased intraoperative blood loss and the need for blood transfusion. The impact of pancreatoduodenectomy (PD) with early ligation of the inferior pancreatoduodenal artery (IPDA) on intraoperative blood loss and short-term outcomes is not well known.


METHODS
A retrospective review of patients who underwent standard PD (n = 112) and pancreatoduodenectomy with early ligation of the IPDA (n = 175) was undertaken.


RESULTS
Early ligation of the IPDA, body mass index, sex, and operative time were independent risk factors for intraoperative blood loss. Intraoperative median blood loss in patients with early ligation of the IPDA was 380 ml, which was significantly lower than 850 ml in patients who had a standard PD (p < 0.001). Although 51 patients (46%) with standard PD needed a perioperative blood transfusion, only four patients (2%) with early ligation of the IPDA received a perioperative red cell transfusion (p < 0.001). The overall complication rates were 61% for patients with standard PD versus 45% for patients with early ligation of the IPDA (p = 0.007). There were five in-hospital deaths (4.5%) of patients with standard PD versus zero in-hospital deaths (0.0%) of patients with early ligation of the IPDA (p = 0.002).


CONCLUSIONS
Early ligation of the inferior pancreatoduodenal artery not only reduced intraoperative blood loss during PD but also alleviated postoperative morbidity and mortality.
Ishizaki
Yoichi
Y
Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. ishizaki@juntendo.ac.jp
Sugo
Hiroyuki
H
Yoshimoto
Jiro
J
Imamura
Hiroshi
H
Kawasaki
Seiji
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002648:Child; D004386:Duodenum / Q000098:blood supply*; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult