Postoperative results after pylorus-preserving pancreaticoduodenectomy using Delpero's omental flap

Background:

Clinically relevant postoperative pancreatic fistula (POPF) is one of the main causes for morbidity and mortality after pancreaticoduodenectomy. The German RECOPANC trial observed about 20% grade B or C fistulas independent of the technique of reconstruction used. The intraoperative use of an omental flap for coverage of the celiac and mesenteric vessels was described to potentially reduce the risk of erosion bleeding in patients with POPF.

Methods:

The medical records of 50 consecutive patients, who underwent a pylorus-preserving pancreaticoduodenectomy (PPPD) with Delpero's omental flap in Johannes Wesling Klinikum Minden during the last two years were retrospectively reviewed. The method of reconstruction used was a pancreaticogastrostomy. The rate of POPF was evaluated in all patients. The fistulas were classified as grade A, B or C fistula using the ISGPF-classification. Furthermore, the 30-d mortality rate was evaluated.

Results:

11 of 50 patients developed a grade A fistula without clinical relevance. There were 4 (8.0%) clinically relevant fistulas counted; 2 grade B fistulas (4.0%) and 2 grade C fistulas (4.0%). 2 patients (4.0%) died within 30 days after the surgical treatment, both of them of non surgical origin.

Conclusions:

Compared to recent trials the rate of clinically relevant postoperative pancreatic fistula grade B/C is low. The use of the omental flap is a promising technique to reduce the rate of POPF.

This Abstract is accepted as a poster presentation at the annual congress 2017 of the „Vereinigung der NRW-Chirurgen“ (P19)