Wrapping The Gastroduodenal Artery Stump During Pancreatoduodenectomy Decreased Its Postoperative Hemorrhage Incidence

Background：Pancreaticoduodenectomy is the most commonly used surgical proceduresfor periampullary tumors。The postoperative gastroduodenal artery stump hemorrhage isone of the most serious complications, often occurs1to4weeks after the surgery. Thepurpose of this study is to determine whether wrapping the gastroduodenal artery stumpduring pancreatoduodenectomy could decrease the incidence of the postoperativegastroduodenal artery stump hemorrhage.Materials and Methods：1. Patient materialsA retrospective review involving161patients who underwent Pancreaticoduodenectomyfrom2007to2011for malignant (n=153) and benign (n=8) diseases was performed.Collect age, sex, preoperative routine examination results, intraoperative blood loss,operation time, postoperative complications, pathology diagnosis, as well as all kinds ofinformation of these patients.2. Surgery and grouping methodWrapping the gastroduodenal artery stump during pancreatoduodenectomy was definedas “Wrapping the gastroduodenal artery stump using the teres hepatis ligamentum duringpancreatoduodenectomy.”87patients accepted the “wrapping” procedure (wrappinggroup). The other74patients didn’t apply the “wrapping” procedure (nonwrappinggroup).3. Statistical analysis methodComparison of categorical and continuous variables were performed using χ2test andStudent’s t-test, respectively. univariate and multivariate sequential analysis of riskfactors for gastroduodenal artery stump hemorrhage were performed using the binarylogistic regression. A P value <0.05was considered statistically signifcant.Results：There were no significant differences in patient characteristics between twogroups. After wrapping，the incidence of postoperative gastroduodenal artery stumpbleeding decreased significantly (1/87vs9/74, P=0.006). The rates of the otherpostoperative complications showed no significant differences. Univariate andmultivariate sequential analysis showed that pancreatic fistula (P=0.008, OR=7.513,95%CI=1.686～33.480) and wrapping the gastroduodenal artery stump using the tereshepatis ligamentum during pancreatoduodenectomy (P=0.025, OR=0.089,95%CI=0.011～0.737) were associated with the risk factors of postoperative gastroduodenal artery stump hemorrhage.Conclusion： Postoperative pancreatic fistula is the risk factor of postoperativegastroduodenal artery stump hemorrhage. Wrapping the gastroduodenal artery stumpwith the teres hepatis ligamentum during pancreatoduodenectomy can significantlyreduce the incidence of postoperative gastroduodenal artery stump hemorrhage，is aprotective factor. But，the “wrapping” procedure can not decrease the rates of the othercomplications after pancreatoduodenectomy.