title: Omental flap wrapping with fixation to the cut surface of the liver for reducing delayed gastric emptying after left-sided hepatectomy.
abstract: BACKGROUND
  Delayed gastric emptying (DGE) is a common complication following left-sided hepatectomy. The goal of this study was to clarify the clinical implications of an omental flap wrapping procedure that includes fixation to the cut surface of the liver to reduce the incidence of DGE after left-sided hepatectomy.
  
  
  METHODS
  The study included 50 consecutive patients who underwent left-sided hepatectomy between January 2000 and July 2011. Clinicopathologic risk factors for DGE after left-sided hepatectomy were identified using univariate and multivariate models. The incidence of DGE, digestive symptoms, and postoperative complications were compared between two groups: 25 patients treated with the omental flap wrapping and fixation procedure and 25 patients who did not receive such a flap.
  
  
  RESULTS
  A univariate analysis revealed that a lack of the omental flap, the lymph node clearance, and use of left hemihepatectomy were associated with postoperative DGE. The multivariate analysis indicated that the lack of the omental flap was the only independent significant factor associated with the DGE (odds ratio, 21.23; p = 0.0002). There was a significant difference in the incidence of DGE between the patients with (4 %) and without an omental flap (36 %). The incidence of gastric distension and the use of prokinetic drugs were also significantly lower in patients with an omental flap than in patients without the flap, and patients with an omental flap resumed a solid diet significantly earlier.
  
  
  CONCLUSIONS
  This retrospective single-center study revealed that it was possible to reduce the incidence of DGE using a procedure involving omental flap wrapping with fixation to the cut surface of the liver after left-sided hepatectomy.
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan, kokano@kms.ac.jp.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Okano
authors.forename: Eisuke
authors.initials: E
authors.lastname: Asano
authors.forename: Minoru
authors.initials: M
authors.lastname: Oshima
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yachida
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishizawa
authors.forename: Shintaro
authors.initials: S
authors.lastname: Akamoto
authors.forename: Masao
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Akihiro
authors.initials: A
authors.lastname: Deguchi
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D005746:Gastric Emptying; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology* / Q000517:prevention & control*; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D013524:Surgical Flaps; D055815:Young Adult