Jayaratnam Sisira, Tandup Cherring, Sakaray Yashwant Raj, ChKurdia Kailash, Gupta Ashish, Kaman Lileswar
Department of General Surgery, PGIMER, Chandigarh, India.
Department of General Surgery, AIMS, Mohali, India.
Ann Hepatobiliary Pancreat Surg. 2024 Aug 31;28(3):358-363. doi: 10.14701/ahbps.24-016. Epub 2024 Jun 5.
BACKGROUNDS/AIMS: Pancreaticoduodenectomy (PD) is being performed more frequently. A pancreaticojejunostomy (PJ) leak is the major determinant of patient outcomes. An omental flap around PJ might improve postoperative outcomes.
A prospective randomized controlled trial was planned at PGIMER, Chandigarh. Fifty-eight patients meeting the criteria were included in the study. Group A underwent PD with omental roll-up and group B underwent standard PD.
The mean age of patients in group A was 57.1 ± 14.3 years and 51.2 ± 10.7 in group B. Jaundice ( = 0.667), abdominal pain ( = 0.69), and co-morbidities were equal among the groups. The body mass index of patients in group B was higher at 24.3 ± 5.4 kg/m ( = 0.03). The common bile duct diameter (12.6 ± 5.3 mm vs. 17.2 ± 10.3 mm, = 0.13) and the pancreatic duct diameter (4.06 ± 2.01 mm vs. 4.60 ± 2.43 mm, = 0.91) were comparable. The intraoperative blood loss (mL) was significantly higher in group B (233.33 ± 9.57 vs. 343.33 ± 177.14, = 0.04). Drain fluid amylase levels on postoperative day (POD) 1 ( = 0.97) and POD3 ( = 0.92) were comparable. The rate of postoperative pancreatic fistula (POPF) grade A ( ≥ 0.99) and grade B ( = 0.54) were comparable. The mean postoperative length of stay among was similar ( = 0.89).
An omental wrap can be performed without increase in complexity of the procedure. However, its utility in preventing POPFs and morbidity remains unclear.
背景/目的：胰十二指肠切除术（PD）的实施频率越来越高。胰肠吻合口（PJ）漏是决定患者预后的主要因素。PJ周围的网膜瓣可能会改善术后预后。
在昌迪加尔的PGIMER计划进行一项前瞻性随机对照试验。58例符合标准的患者被纳入研究。A组接受带网膜卷包的PD，B组接受标准PD。
A组患者的平均年龄为57.1±14.3岁，B组为51.2±10.7岁。两组间黄疸（P = 0.667）、腹痛（P = 0.69）和合并症情况相同。B组患者的体重指数较高，为24.3±5.4kg/m²（P = 0.03）。胆总管直径（12.6±5.3mm对17.2±10.3mm，P = 0.13）和胰管直径（4.06±2.01mm对4.60±2.43mm，P = 0.91）具有可比性。B组术中失血量（mL）显著更高（233.33±9.57对343.33±177.14，P = 0.04）。术后第1天（POD1）（P = 0.97）和POD3（P = 0.92）的引流液淀粉酶水平具有可比性。术后A级胰瘘（POPF）（P≥0.99）和B级胰瘘（P = 0.54）的发生率具有可比性。两组术后平均住院时间相似（P = 0.89）。
进行网膜包裹不会增加手术的复杂性。然而，其在预防POPF和降低发病率方面的效用仍不明确。
