A Meta-Analysis Of The Effect Of Omental Wrapping Technique On The Prevention Of Complications After Pancreatoduodenectomy

Objective:To systematically evaluate the efficacy and safety of greater omentum wrapping pancreatic-enteric anastomosis for the prevention of postoperative pancreatic fistula(POPF),postpancreatectomy hemorrhage(PPH)and other postoperative complications after pancreaticoduodenectomy(PD).Method:Search relevant Chinese and English databases such as CNKI,Wanfang Data Knowledge Service Platform,VIP,CBM,Cochrane Library,Pub Med,Embase and Web of Science.The original clinical studies on the effect of greater omentum wrapping of pancreatic-enteric anastomosis on postoperative complications in pancreatoduodenectomy from the establishment of the database to November 2022 were retrieved and the data were extracted for analysis.Results:A total of 15 studies with a total of 1830 cases were included in this study,including 980 cases in the omental wrapping group and 850 cases in the non-omental wrapping group.The results of meta-analysis showed that: The overall incidence of POPF was lower in the omental wrapping group than in the non-omental wrapping group(OR=0.30,95% CI: 0.22～0.41,P<0.001).Subgroup analysis suggested that the incidence of grade B/C POPF was lower in the omental wrapping group than in the non-omental wrapping group(OR=0.29,95% CI: 0.21～0.39,P<0.001).Compared with the non-omental group,PPH(OR=0.35,95% CI: 0.24～0.53,P<0.001),delayed gastric emptying(DGE)(OR=0.45,95% CI: 0.31～0.64,P<0.001),abdominal infection(OR=0.55,95% CI: 0.40～0.75,P<0.001),reoperation(OR=0.31,95% CI: 0.18～0.54,P<0.001),and death at 30 days postoperatively(OR=0.42,95% CI: 0.22～0.80,P=0.009)were less prevalent.The postoperative hospital stay was shorter(MD=-2.44,95% CI:-4.10～-0.77,P=0.004),and the open diet was earlier(MD=-0.98,95% CI:-1.84～-0.11,P=0.03).There were no statistically significant difference in operation time(MD=-13.68,95% CI:-28.31～0.95,P=0.07)and intraoperative blood loss(MD=-17.26,95% CI:-57.55～23.03,P=0.40)between the two groups.Conclusion:The omental wrapping technique can reduce the incidence of postoperative complications such as pancreatic fistula,postpancreatectomy hemorrhage,abdominal infection,and delayed gastric emptying,improve prognosis,shorten hospital stay,without increasing surgical difficulty or operation time.