Detailed Abstract
[Poster Presentation 4 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[BP PP 4-S5] Omental Roll-Up Technique in Pancreatico-Jejunostomy as a Preventive Strategy for Post-Operative Pancreatic Fistula After Pancreatico-Duodenectomy: A Single Centre, Prospective, Randomized, Controlled Trial.
Ashish LIMBANI1, Sisira JAYARATNAM1, Lileswar KAMAN1, Cherring TANDUP1, Yashwant Raj SAKARAY1
1Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh., India
Background : Post-Operative Pancreatic Fistula (POPF) remains a major cause of morbidity and mortality after Pancreatico-Duodenectomy. This study aims to explore the effect of omental wrapping over Pancreatico-Jejunostomy in preventing POPF, post-operative morbidities, mortality.
Methods : In this prospective, randomized study conducted at a premier tertiary institute of India, 30 patients randomly underwent either omental roll-up in Pancreatico-Jejunostomy (Group A; 15) or standard Pancreatico-Jejunostomy without omental roll-up (Group B; 15) during Pancreatico-Duodenectomy. In Omental roll-up group, greater omental flap with 1 or 2 omental branches of gastroepiploic vessels was pulled through between posterior surface of Pancreatico-Jejunostomy and the Portal Vein and rolled over to anterior surface of Pancreatico-Jejunostomy and sutured to seromuscular layer of jejunum and pancreatic parenchyma. The primary objective was the incidence of POPF.
Results : Mean age was 54.17±12.8 years, (57.1±14.3 years vs 51.2±10.7 years, p=0.455). Overall, 11 (36.7%) patients developed POPF, 5 (33.3%) vs 6 (40%), p=0.705. 8 patients developed biochemical leak (4 vs 4, p=1). 3 patients developed Grade B POPF, 1 in omental roll-up group and 2 in standard Pancreatico-Jejunostomy group. (6.7% vs 13.3%, p=0.543). None of the patients developed grade C fistula. Mean intra-operative blood loss was more in standard Pancreatico-Jejunostomy group, 233.33 ± 95.743 ml (Group A) vs 343.33 ± 177.147 ml (Group B) (p=0.043). No significant difference was observed in the incidence or severity of Delayed Gastric Emptying between 2 groups (7 vs 6, p=0.713) or Surgical Site Infection (3 vs 3, p=1). None of the patients developed Post-Pancreatectomy Haemorrhage. Length of hospital stay was more in omental wrapping group, but was statistically insignificant (14.93 ± 5.7 days vs 14.67 ± 4.92 days; p=0.892).
Conclusions : The incidence and severity of post-operative pancreatic fistula was less in omental wrapping group, though statistically insignificant. Larger multicentric RCTs are required to evaluate the roll of omental roll-up technique in preventing POPF.
Methods : In this prospective, randomized study conducted at a premier tertiary institute of India, 30 patients randomly underwent either omental roll-up in Pancreatico-Jejunostomy (Group A; 15) or standard Pancreatico-Jejunostomy without omental roll-up (Group B; 15) during Pancreatico-Duodenectomy. In Omental roll-up group, greater omental flap with 1 or 2 omental branches of gastroepiploic vessels was pulled through between posterior surface of Pancreatico-Jejunostomy and the Portal Vein and rolled over to anterior surface of Pancreatico-Jejunostomy and sutured to seromuscular layer of jejunum and pancreatic parenchyma. The primary objective was the incidence of POPF.
Results : Mean age was 54.17±12.8 years, (57.1±14.3 years vs 51.2±10.7 years, p=0.455). Overall, 11 (36.7%) patients developed POPF, 5 (33.3%) vs 6 (40%), p=0.705. 8 patients developed biochemical leak (4 vs 4, p=1). 3 patients developed Grade B POPF, 1 in omental roll-up group and 2 in standard Pancreatico-Jejunostomy group. (6.7% vs 13.3%, p=0.543). None of the patients developed grade C fistula. Mean intra-operative blood loss was more in standard Pancreatico-Jejunostomy group, 233.33 ± 95.743 ml (Group A) vs 343.33 ± 177.147 ml (Group B) (p=0.043). No significant difference was observed in the incidence or severity of Delayed Gastric Emptying between 2 groups (7 vs 6, p=0.713) or Surgical Site Infection (3 vs 3, p=1). None of the patients developed Post-Pancreatectomy Haemorrhage. Length of hospital stay was more in omental wrapping group, but was statistically insignificant (14.93 ± 5.7 days vs 14.67 ± 4.92 days; p=0.892).
Conclusions : The incidence and severity of post-operative pancreatic fistula was less in omental wrapping group, though statistically insignificant. Larger multicentric RCTs are required to evaluate the roll of omental roll-up technique in preventing POPF.
SESSION
Poster Presentation 4
Zone E 3/21/2024 2:50 PM - 3:30 PM