title: Use of omentum or falciform ligament does not decrease complications after pancreaticoduodenectomy: nationwide survey of the Japanese Society of Pancreatic Surgery.
abstract: BACKGROUND
  Wrapping is thought to prevent pancreatic fistula and postoperative hemorrhage for pancreaticoduodenectomy (PD), and we analyzed whether omentum/falciform ligament wrapping decreases postoperative complications after PD.
  
  
  METHODS
  This is a retrospective study of wrapping using the omentum/falciform ligament in patients that underwent PD between January 2006 and June 2008 in 139 institutions that were members of the Japanese Society of Pancreatic Surgery.
  
  
  RESULTS
  Ninety-one institutions responded to the questionnaires, and data were accumulated from 3,288 patients. The data from 2,597 patients were acceptable for analysis; 918 (35.3%) patients underwent wrapping and 1,679 patients did not. A pancreatic fistula occurred in 623 patients (37.3%) in the nonwrapping group, in comparison to 393 patients (42.8%) in the wrapping group (P = .006). The incidence of a grade B/C pancreatic fistula was lower in the nonwrapping group than the wrapping group (16.7% vs. 21.5%; P = .002). An intra-abdominal hemorrhage occurred in 54 patients (3.2%) in the nonwrapping group, which was similar to the incidence in the wrapping group (32 patients; 3.5%). The mortality was 1.3% and 1.0% in nonwrapping and wrapping groups, respectively. A multivariate analysis revealed 7 independent risk factors for pancreatic fistula; male, hypoalbuminemia, soft pancreas, long operation time, extended resection, pylorus preservation, and omentum wrapping. There were 4 independent risk factors for early intra-abdominal hemorrhage and 2 independent risk factors for late intra-abdominal hemorrhage.
  
  
  CONCLUSIONS
  This retrospective study revealed that omentum wrapping did not decrease the incidence of pancreatic fistula. An additional validation study is necessary to evaluate the efficacy of wrapping for PD.
authors: Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan.
authors: Masaji
authors: M
authors: Tani
authors: Manabu
authors: M
authors: Kawai
authors: Seiko
authors: S
authors: Hirono
authors: Takashi
authors: T
authors: Hatori
authors: Toshihide
authors: T
authors: Imaizumi
authors: Akimasa
authors: A
authors: Nakao
authors: Shinichi
authors: S
authors: Egawa
authors: Takehide
authors: T
authors: Asano
authors: Takukazu
authors: T
authors: Nagakawa
authors: Hiroki
authors: H
authors: Yamaue
mesh_terms: D000368:Aged; D003625:Data Collection; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009852:Omentum / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D012955:Societies, Medical