Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2022; 14(5): 482-493
Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.482
Application of omental interposition to reduce pancreatic fistula and related complications in pancreaticoduodenectomy: A propensity score-matched study
Yang Li, Yun Liang, Yao Deng, Zhi-Wei Cai, Ming-Jian Ma, Long-Xiang Wang, Meng Liu, Hong-Wei Wang, Chong-Yi Jiang
Yang Li, Yun Liang, Yao Deng, Zhi-Wei Cai, Ming-Jian Ma, Long-Xiang Wang, Meng Liu, Hong-Wei Wang, Chong-Yi Jiang, Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
Yun Liang, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Author contributions: Li Y, Liang Y, and Deng Y contributed equally to this manuscript; Jiang CY participated in the conception and design of this study; Deng Y, Cai ZW, Ma MJ, Wang LX, Liu M, and Wang HW participated in the data collection; Li Y participated in the data collection, analysis, and drafting of the article; Liang Y participated in the design of the study and data analyses; All authors have read and approved the final manuscript.
Supported by the Shanghai Science and Technology Commission of Shanghai Municipality, No. 20Y11908600; the Shanghai Shenkang Hospital Development Center, No. SHDC2020CR5008; and Shanghai Municipal Health Commission, No. 20194Y0195.
Institutional review board statement: The study was reviewed and approved by the Ethics Review Committee of Huadong Hospital (Shanghai).
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chong-Yi Jiang, MD, Chief Doctor, Department of General Surgery, Huadong Hospital Affiliated to Fudan University, No. 221 West Yan’an Road, Shanghai 200040, China. jiangzhongyi9@sina.com
Received: December 16, 2021
Peer-review started: December 16, 2021
First decision: March 13, 2022
Revised: March 16, 2022
Accepted: April 24, 2022
Article in press: April 24, 2022
Published online: May 27, 2022
Abstract
BACKGROUND

The life-threatening complications following pancreatoduodenectomy (PD), intra-abdominal hemorrhage, and postoperative infection, are associated with leaks from the anastomosis of pancreaticoduodenectomy. Although several methods have attempted to reduce the postoperative pancreatic fistula (POPF) rate after PD, few have been considered effective. The safety and short-term clinical benefits of omental interposition remain controversial.

AIM

To investigate the safety and feasibility of omental interposition to reduce the POPF rate and related complications in pancreaticoduodenectomy.

METHODS

In total, 196 consecutive patients underwent PD performed by the same surgical team. The patients were divided into two groups: An omental interposition group (127, 64.8%) and a non-omental interposition group (69, 35.2%). Propensity score-matched (PSM) analyses were performed to compare the severe complication rates and mortality between the two groups.

RESULTS

Following PSM, the clinically relevant POPF (CR-POPF, 10.1% vs 24.6%; P = 0.025) and delayed postpancreatectomy hemorrhage (1.4% vs 11.6%; P = 0.016) rates were significantly lower in the omental interposition group. The omental interposition technique was associated with a shorter time to resume food intake (7 d vs 8 d; P = 0.048) and shorter hospitalization period (16 d vs 21 d; P = 0.031). Multivariate analyses showed that a high body mass index, nonapplication of omental interposition, and a main pancreatic duct diameter < 3 mm were independent risk factors for CR-POPF.

CONCLUSION

The application of omental interposition is an effective and safe approach to reduce the CR-POPF rate and related complications after PD.

Keywords: Pancreaticoduodenectomy, Pancreatic fistula, Complication, Omental interposition

Core Tip: Postoperative pancreatic fistula (POPF) is a life-threatening complication after pancreaticoduodenectomy. Multiple methods have been described in the literature to prevent POPF; however, few trials have demonstrated that a certain method can achieve good clinical outcomes. In this study, we proved that the application of omental interposition can reduce the incidence of clinically relevant POPF, which is associated with a trend towards accelerated recovery.