Wrapping the hepatic artery with detached ligamentum teres hepatis on preventing abdominal hemorrhage after pancreaticoduodenectomy

Abstract

Objective To explore the efficacy of wrapping the hepatic artery with detached ligamentum teres hepatis during pancreaticoduodenectomy (PD) on preventing postoperative intra-abdominal hemorrhage. Methods A total of 186 patients who received PD in the First Affiliated Hospital of Xinjiang Medical University from June 2020 to June 2022 were divided into wrapping group (n=86) and non-wrapping group (n=100) according to whether the detached ligamentum teres hepatis was used to wrap the hepatic artery during the operation. The clinical data on perioperative and postoperative complications were collected and retrospectively analyzed in two groups. Results PD was successfully performed and completed in both groups, and there was no significant difference in age, gender, BMI, length of hospital stay, operative time and intra-operative blood loss between two groups (P＞0.05) . The incidences of pancreatic fistula, biliary fistula and abdominal infection were similar in two groups (P＞0.05) , but the incidence of postoperative bleeding in wrapping group was significantly lower than that in non-wrapping group (1.16% vs 9.00%, P＜0.05) . Logistic regression analysis showed that the pancreatic and biliary fistulas of grade B/C were the independent risk factors for postoperative abdominal bleeding after PD (P＜0.05) , and the wrapping of the hepatic artery with the detached hepatic round ligament during operation was an independent protective factor for postoperative abdominal bleeding after PD (P＜0.05) . Conclusion Wrapping the hepatic artery with detached ligamentum teres hepatis during PD surgery may reduce the incidence of postoperative abdominal bleeding and is simple, safe and feasible to perform without additional complications．

Keywords

• pancreaticoduodenectomy
• postoperative complication
• abdominal hemorrhage
• ligamentum teres hepatis
• detached
• hepatic artery