title: Protection of major vessels and pancreaticogastrostomy using the falciform ligament and greater omentum for preventing pancreatic fistula in soft pancreatic texture after pancreaticoduodenectomy.
abstract: OBJECTIVE
  Pancreatic fistula is one of the major causes of morbidity in patients undergoing pancreaticoduodenectomy. Protection of the skeletonized vessels and the anastomotic site of pancreaticoenterostomy is one of the surgical options to prevent the development of a pancreatic fistula. The aim of this study was to describe an operative technique to protect the vessels and anastomotic site by wrapping them with the falciform ligament and the greater omentum.
  
  
  METHODS
  After a modified subtotal stomach-preserving pancreaticoduodenectomy reconstruction with pancreaticogastrostomy was performed, the falciform ligament and greater omentum was used on the skeletonized major vessels and wrapped around the anastomotic site of pancreaticogastrostomy. Twenty consecutive patients were enrolled in this prospective study.
  
  
  RESULTS
  The entire procedure did not result in any operative complications. Postoperative pancreatic fistula developed in 2 cases (10%). According to the international postoperative pancreatic fistula criteria, grade A and grade B was observed in 1 case each. No intra-abdominal hemorrhage and late intra-abdominal abscess were observed.
  
  
  CONCLUSIONS
  This procedure is a convenient and safe technique, and may be helpful in preventing major complications caused by pancreatic fistula.
authors.affiliation: Department of Surgery, Social Insurance Yokohama Central Hospital, Japan. mimatsu.kenji@yokochu.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Mimatsu
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Oida
authors.forename: Hisao
authors.initials: H
authors.lastname: Kano
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawasaki
authors.forename: Nobutada
authors.initials: N
authors.lastname: Fukino
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Kida
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kuboi
authors.forename: Sadao
authors.initials: S
authors.lastname: Amano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery*; D010179:Pancreas / Q000098:blood supply*; D010185:Pancreatic Fistula / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies