Clinical Efficacy Of Omentum Wrapped Pancreatic Anastomotic Stoma In Prevention Of Pancreatic Leakage

Objective: To evaluate the clinical effect of the application of omentum in the treatment of pancreatic leakage after pancreaticoduodenectomy(PD).Methods: clinical data of 77 patients who underwent pancreaticoduodenectomy in our department between January 2011 and December 2016 were analyzed retrospectively.The patients were divided into 2 groups according to the treatment of pancreatic and intestinal anastomosis.There were 18 males and 13 females in the omental wrapping group,respectively,with an age range of 31-76 years,and an average age of 62.58±10.38.There were 25 males and 21 females in the non omental wrapping group,with an age range of 21-78 years and an average age of 59.196±12.783.The application of the principle of statistics comparative analysis of two groups of patients with general information(age,gender,body mass index,total bilirubin,albumin,history of abdominal surgery,complications),general data(operation time,intraoperative bleeding,blood transfusion cases,texture of pancreas,pancreatic duct diameter)and postoperative pathological data,complications after the operation(perioperative death,pancreatic fistula,bleeding,bile leakage,ascites,abdominal infection,intestinal obstruction,pulmonary infection,incision infection and multiple organ dysfunction),postoperative general information(eating time,indwelling time of drainage tube,ICU hospitalization time,hospitalization time,reoperation rate).Results: 1.The omental wrapping group and non omental wrapping group preoperative demographic data(gender,age,body mass index,serum albumin,total bilirubin,abdominal surgery history,puncture complications and jaundice)had no significant difference(P > 0.05).2.The general information and postoperative pathological data of omental wrapping group and non omental wrapping group(operation time,bleeding volume,blood transfusion cases,drainage of pancreatic juice,pancreatic texture and pancreatic duct diameter)had no significant difference(P > 0.05).3.There were 8 cases(25.81%)of complications in the omental wrapping group,19 cases in the non omental wrapping group(41.30%),5 cases died after operation,including 1 cases(3.23%)in the omental wrapping group,and 4 cases(8.70%)in the non omental wrapping group.There was no significant difference in the total complication rate and mortality between the two groups(P > 0.05).4.There were 2 cases(6.45%)of biochemical leakage in the omental wrapping group,and 11 cases in the non omental wrapping group(23.91%),the difference between the two groups was statistically significant(P < 0.05).5.There were 1 case of grade C pancreatic fistula(3.23%),and 1 case of grade B pancreatic fistula(3.23%)in the omental wrapping group;2 cases(4.35%)of grade B pancreatic fistula were in the non omental wrapping group,and 2 cases with C grade pancreatic leakage(4.35%).The incidence of pancreatic fistula(grade B+grade C)was not significantly different between the two groups(P > 0.05).6.The postoperative hemorrhage(0%vs6.52%),gastric emptying disorder(0%vs4.35%)and ascites(6.45%vs19.57%),abdominal infection(6.45%vs15.22%),intestinal obstruction(0%vs2.17%),multiple organ dysfunction(0%vs4.35%)and other complications compared with no significant difference(P > 0.05).7.The omental wrapping group and non omental wrapping group in the postoperative general information(ICU hospitalization time,postoperative blood transfusion,the number of cases of gastric tube indwelling time,indwelling time of the peritoneal drainage tube,postoperative hospitalization time,reoperation rate)had no significant difference(P > 0.05).Conclusion: 1.Omental wrapping pancreatic enteric anastomosis can not reduce incidence rate of pancreatic fistula(grade B+grade C)after pancreaticoduodenectomy.2.The omental wrapping pancreatic enteric anastomosis can reduce the incidence of postoperative biochemical leakage,but the incidence of postoperative complications and postoperative recovery of PD are not significantly effected.