title: Use of a falciform ligament pedicle flap to decrease pancreatic fistula after distal pancreatectomy.
abstract: OBJECTIVE
  Postoperative pancreatic fistula (POPF) remains a significant source of morbidity after distal pancreatectomy (DP). We describe a technique for coverage of the pancreatic stump after DP using a pedicled falciform ligament flap with a low POPF rate.
  
  
  METHODS
  A retrospective review of clinical, radiographic, and pathologic variables of patients undergoing open DP between November 2005 and August 2009 was performed. After standardized DP, the pancreatic stump was closed using a pedicled falciform ligament flap. Postoperative pancreatic fistula was defined using the International Study Group classification for pancreatic fistula definition.
  
  
  RESULTS
  Twenty-three consecutive patients underwent open DP and splenectomy with closure of the pancreatic stump using a pedicled falciform ligament flap. Pancreatic transection and stump closure was performed in a uniform fashion in all patients. Eight patients (35%) had additional organs resected. Two patients (8.7%) developed grade C POPFs, which were successfully managed with percutaneous drain placement. No additional patients developed a POPF or abdominal abscess. The median length of stay was 5 days. There were no perioperative mortalities.
  
  
  CONCLUSIONS
  We conclude that use of a pedicled falciform ligament flap for coverage of the pancreatic stump is associated with a low incidence of POPF. Continued investigation of this technique is warranted.
authors.affiliation: Department of Surgery, The University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Dustin M
authors.initials: DM
authors.lastname: Walters
authors.forename: Jayme B
authors.initials: JB
authors.lastname: Stokes
authors.forename: Reid B
authors.initials: RB
authors.lastname: Adams
authors.forename: Todd W
authors.initials: TW
authors.lastname: Bauer
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008022:Ligaments / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome