title: Falciform ligament wrap for prevention of gastroduodenal artery bleed after pancreatoduodenectomy.
abstract: The present study aims to assess the effectiveness and current evidence of a pedicled falciform ligament wrap around the gastroduodenal artery stump for prevention of erosion hemorrhage after pancreatoduodenectomy (PD).
  
  
  
  Retrospective data were pooled for meta-analysis. At the own center, patients who underwent PD between 2012 and 2015 were retrospectively analyzed based on the intraoperative performance of the wrap. A systematic literature review and meta-analysis was performed that combined the published and the obtained original data. The following databases were searched: Medline, Embase, Web of Science, and the Cochrane Library.
  
  
  
  At the own center, a falciform ligament wrap was performed in 39 of 196 PDs (20%). The wrap group contained more ampullary neoplasms, but the pancreatic fistula rate was not significantly different from the nonwrap group (28% versus 32%). In median, erosion hemorrhage occurred after 21.5 d, and it was lethal in 39% of the patients. Its incidence was not significantly lower in the wrap group (incidence: 7.7% versus 9.6% in the nonwrap group). The systematic literature search yielded four retrospective studies with a high risk of bias; only one study was controlled. When the five data sets of published and own cases with a falciform ligament wrap were pooled, the incidence of erosion hemorrhage was 5 of 533 cases (0.9%) compared with 24 of 297 cases (8.1%) without the wrap.
  
  
  
  The reported incidence of erosion hemorrhage after the falciform ligament wrap is low, but there are still insufficient controlled data to support its general use.
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Müssle
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Ann
authors.initials: A
authors.lastname: Wierick
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Distler
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Electronic address: thilo.welsch@uniklinikum-dresden.de.
authors.forename: Thilo
authors.initials: T
authors.lastname: Welsch
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000601:surgery*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bleeding; Falciform ligament; Gastroduodenal artery; Pancreatic fistula; Pancreatoduodenectomy; Round ligament