Usefulness of Hem-o-lok® clips to ligate the gastroduodenal artery in pancreatoduodenectomy.

Autor:	Kubo N; Department of Surgery, Gunma Prefecture Saiseikai Maebashi Hospital, Maebashi, Japan. Electronic address: nkubo@gunma-u.ac.jp., Suzuki S; Department of Surgery, Gunma Prefecture Saiseikai Maebashi Hospital, Maebashi, Japan., Seki T; Department of Surgery, Gunma Prefecture Saiseikai Maebashi Hospital, Maebashi, Japan., Fukushima R; Department of Surgery, Gunma Prefecture Saiseikai Maebashi Hospital, Maebashi, Japan., Furuke S; Department of Surgery, Gunma Prefecture Saiseikai Maebashi Hospital, Maebashi, Japan., Yagi N; Department of Surgery, Gunma Prefecture Saiseikai Maebashi Hospital, Maebashi, Japan., Ooki T; Department of Surgery, Gunma Prefecture Saiseikai Maebashi Hospital, Maebashi, Japan., Aihara R; Department of Surgery, Gunma Prefecture Saiseikai Maebashi Hospital, Maebashi, Japan., Araki K; Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan., Hosouchi Y; Department of Surgery, Gunma Prefecture Saiseikai Maebashi Hospital, Maebashi, Japan., Shirabe K; Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2024 Dec; Vol. 26 (12), pp. 1521-1527. Date of Electronic Publication: 2024 Sep 03.
DOI:	10.1016/j.hpb.2024.08.014
Abstrakt:	Background/purpose: Post-pancreatectomy hemorrhage (PPH) is a fatal complication of pancreatoduodenectomy. When complicated by a pancreatic fistula, pancreatic juice contacting the artery may form a pseudoaneurysm and cause arterial bleeding. We used Hem-o-lok® clips to prevent damage to the outer wall of the gastroduodenal artery (GDA). This study evaluated the usefulness of using Hem-o-lok® clips to ligate the GDA stump to prevent PPH. Methods: Overall, 468 patients who underwent PD at our hospital were included. Before July 2020, we ligated the GDA stump using the knot-tying method, which involves double ligation. After July 2020, the GDA stump was double clipped using a 10-mm Hem-o-lok® clip to the residual side without tension on the GDA. Propensity score matching was used to compare cases of pancreatic fistulas that underwent clipping vs. knot-tying. Results: Propensity score matching resulted in 37 patients in each group. PPH occurred in 12 (16.4%) and 4 (6.9%) patients in the knot-tying and clipping groups, respectively. PPH from the GDA stump occurred in eight (11.0%) and one (1.7%) patient in the knot tying and clipping groups, respectively (P = 0.044). Conclusions: Hem-o-lok® clips are safe to apply on the GDA stump during pancreatoduodenectomy to prevent PPH. (Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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