title: Preventive effect of omental flap in pancreaticoduodenectomy against postoperative pseudoaneurysm formation.
abstract: OBJECTIVE
  An omental flap covering the splanchnic vessels might reduce postoperative intraabdominal hemorrhage after pancreaticoduodenectomy. However, the efficiency of such a procedure remains to be verified. The purpose of this study was to determine the effect of omental flap placement in pancreaticoduodenectomy on the incidence of postoperative pseudoaneurysms.
  
  
  METHODS
  Of 229 consecutive patients who underwent pancreaticoduodenectomy, the most recent 157 patients received the omental flap, while the initial 72 patients had no omental flap placement. Various preoperative factors were considered in the evaluation (age, gender, body mass index, primary disease and concurrent disease), as well as operative factors (operation time, blood loss, operative procedures, pancreatic texture, size of pancreatic duct and surgeon's experience).
  
  
  RESULTS
  Eighty-one patients (35.4%) developed pancreatic fistula. Nine patients (3.9%) developed postoperative pseudoaneurysm. Among the patients with pancreatic fistula, those without omental flap developed pseudoaneurysms more frequently (21.7%) than those with omental flap placement (5.2%). Multivariate analysis identified pancreatic fistula, no use of omental flap and hypertension, in that order, as predisposing factors for a pseudoaneurysm. The omental flap significantly prevented pseudoaneurysms (p=0.021; OR=0.151; 95% CI, 0.030-0.751).
  
  
  CONCLUSIONS
  Omental flap placement over splanchnic vessels could be a feasible and efficient surgical procedure to prevent postoperative pseudoaneurysms following pancreaticoduodenectomy.
authors.affiliation: Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan. matsud-h@cc.okayama-u.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sadamori
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Umeda
authors.forename: Susumu
authors.initials: S
authors.lastname: Shinoura
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Yoshida
authors.forename: Daisuke
authors.initials: D
authors.lastname: Satoh
authors.forename: Masashi
authors.initials: M
authors.lastname: Utsumi
authors.forename: Takahito
authors.initials: T
authors.lastname: Yagi
authors.forename: Toshiyoshi
authors.initials: T
authors.lastname: Fujiwara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009852:Omentum / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D016896:Treatment Outcome