title: Falciform ligament flap for the protection of the gastroduodenal artery stump after pancreaticoduodenectomy: A single center experience.
abstract: OBJECTIVE
  Delayed hemorrhage, though rare, remains a significant source of morbidity and mortality after pancreaticoduodenectomy (PD). An important cause of this delayed hemorrhage is erosion or pseudoaneurysm formation of the gastroduodenal artery (GDA) by pancreatic enzymes and adjacent intra-abdominal sepsis. So protection of the GDA stump may avoid this devastating complication.
  
  
  METHODS
  This is a retrospective observational study. All patients, who underwent a PD between August 2007 and December 2014, were included in the study. We used pedicled falciform ligament flap to protect the GDA stump. After PD, pedicled falciform ligament flap was spread widely over the skeletonized hepatic artery including the GDA stump and was fixed to the surrounding retroperitoneal connective tissue. This procedure allowed complete separation of the GDA stump from the pancreatic stump.
  
  
  RESULTS
  We performed 182 cases of PD during the study period. Although, 27 (15%) patients developed pancreatic fistula and six patients developed intra-abdominal abscess, no one experienced hemorrhage due to erosion or pseudoaneurysm formation of the GDA.
  
  
  CONCLUSIONS
  The present surgical option seems to be an effective measure for the prevention of erosion and pseudoaneurysm formation of the GDA after PD.
authors.affiliation: Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A. J. C. Bose Road, 700020 Kolkata, West Bengal, India. Electronic address: drsukantaray@yahoo.co.in.
authors.forename: S
authors.initials: S
authors.lastname: Ray
authors.affiliation: Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A. J. C. Bose Road, 700020 Kolkata, West Bengal, India.
authors.forename: S
authors.initials: S
authors.lastname: Sanyal
authors.affiliation: Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A. J. C. Bose Road, 700020 Kolkata, West Bengal, India.
authors.forename: S
authors.initials: S
authors.lastname: Ghatak
authors.affiliation: Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A. J. C. Bose Road, 700020 Kolkata, West Bengal, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Sonar
authors.affiliation: Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A. J. C. Bose Road, 700020 Kolkata, West Bengal, India.
authors.forename: S
authors.initials: S
authors.lastname: Das
authors.affiliation: Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A. J. C. Bose Road, 700020 Kolkata, West Bengal, India.
authors.forename: S
authors.initials: S
authors.lastname: Khamrui
authors.affiliation: Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A. J. C. Bose Road, 700020 Kolkata, West Bengal, India.
authors.forename: G
authors.initials: G
authors.lastname: Chattopadhyay
mesh_terms: D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: Falciform ligament flap; Hemorrhage; Pancreatic fistula; Pancreaticoduodenectomy