Turrini O, Delpero J R
Département de chirurgie oncologique, institut Paoli-Calmettes, université de la Méditerranée, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France.
J Chir (Paris). 2009 Dec;146(6):545-8. doi: 10.1016/j.jchir.2009.10.004. Epub 2009 Nov 10.
In 1994, a technique of omental flap development and interposition to cover the celiac and mesenteric vessels was described. Its aim was to isolate the pancreatic anastomosis from the vessels dissected during pancreaticoduodenectomy (PD) and thereby to reduce the consequences of postoperative pancreatic fistula - particularly the risk of postoperative bleeding.
We describe this technique adding a simple modification consisting of passage of the pancreatic remnant through an omental window before completion of the pancreaticodigestive anastomosis.
Sixty-four patients underwent PD using an omental flap to cover the celiomesenteric vessels. No postoperative deaths occurred. The rate of PF was 23% and the rate of postoperative hemorrhage was 3% (two patients). No complications related to the omental flap were observed. All postoperative hemorrhages originated from the transected surface of the pancreatic remnant and were successfully treated by transgastrotomy simple suture.
This simple technique has no specific morbidity; it isolates the celiac and mesenteric vessels from the pancreatic anastomosis and therefore may reduce the risk of severe postoperative bleeding after PD.
1994年，一种大网膜瓣展开并置入以覆盖腹腔干和肠系膜血管的技术被描述。其目的是将胰十二指肠切除术（PD）中解剖的血管与胰腺吻合口隔离开，从而减少术后胰瘘的后果，尤其是术后出血的风险。
我们描述了这项技术，并增加了一个简单的改进，即在完成胰消化道吻合之前，将胰腺残端穿过一个网膜窗口。
64例患者接受了使用大网膜瓣覆盖腹腔肠系膜血管的PD手术。无术后死亡病例。胰瘘发生率为23%，术后出血发生率为3%（2例患者）。未观察到与大网膜瓣相关的并发症。所有术后出血均源于胰腺残端的横断表面，并通过经胃切开简单缝合成功治疗。
这项简单的技术没有特定的发病率；它将腹腔干和肠系膜血管与胰腺吻合口隔离开，因此可能降低PD术后严重出血的风险。
