COMBINED USE OF OMENTAL FLAP AND NHS-PEG TO REDUCE THE INCIDENCE OF POSTOPERATIVE COMPLICATIONS AFTER PANCREATODUODENECTOMY
DOI:
https://doi.org/10.11603/2414-4533.2025.4.15737Keywords:
pancreatoduodenectomy, pancreatojejunostomy, omental flap, NHS-PEG, postoperative pancreatic fistula, inflammatory responseAbstract
The aim of the work: to evaluate the effectiveness of using an omental flap to cover the pancreatojejunostomy during pancreatoduodenectomy and to assess the impact of combining the omentum with a biodegradable pad treated with NHS-PEG on postoperative inflammatory response and the incidence of clinically relevant postoperative pancreatic fistula (POPF).
Materials and Methods. A prospective study included 97 patients who underwent pancreatoduodenectomy between 2023 and 2025. Patients were divided into three groups: the control group (n=32, standard PD without anastomotic coverage), the “Omentum without NHS-PEG” group (n=29), and the “Omentum + NHS-PEG” group (n=36). The primary endpoint was the incidence of clinically relevant POPF (Grade B/C according to ISGPS). Secondary endpoints included postoperative dynamics of inflammatory biomarkers (CRP, IL-6, PCT) measured on postoperative days 1, 3, and 7.
Results. The incidence of clinically relevant POPF (Grade B/C) was 18.8 % in the control group, 10.3 % in the omental flap group, and only 5.6 % in the combined “Omentum + NHS-PEG” group. Thus, the combined method reduced the risk of POPF nearly fourfold compared with the control. Analysis of inflammatory biomarkers revealed significantly lower CRP and IL-6 levels in patients with omental coverage, especially in the “Omentum + NHS-PEG” group, starting from postoperative day 1. For PCT, statistically significant differences between groups were observed on day 7. Importantly, the use of the omental flap or NHS-PEG was not associated with additional procedure-related complications or prolonged operative time.
Conclusions. Omental flap coverage of the pancreatojejunostomy reduces postoperative inflammatory response and lowers the risk of clinically relevant POPF following pancreatoduodenectomy. The highest efficacy was achieved with the combined use of omental coverage and NHS-PEG, which can be considered a safe, technically feasible, and promising method for preventing postoperative complications in pancreatic surgery.
References
Andreasi V, Partelli S, Crippa S, Balzano G, Tamburrino D, Muffatti F, Falconi M. A systematic review and meta-analysis on the role of omental or falciform ligament wrapping during pancreaticoduodenectomy. HPB. 2020; 22(9):1227-39. DOI: 10.1016/j.hpb.2020.05.003.
Tani M, Kawai M, Hirono S. Use of omentum or falciform ligament does not decrease complications after pancreaticoduodenectomy: nationwide survey of the Japanese Society of Pancreatic Surgery. Surgery. 2012; 151(2):183-91. DOI: 10.1016/j.surg.2011.07.031.
Shah OJ, Bangri SA, Singh M. Omental flaps reduce complications after pancreaticoduodenectomy. Hepatobiliary & Pancreatic Diseases International. 2015; 14(3):313-19. DOI: 10.1016/S1499-3872(15)60372-1.
Kapoor VK, Behari A, Singh RK, Kumar A. Omental flaps in pancreaticoduodenectomy. Journal of the Pancreas. 2016; 7(6):608-15. DOI: 10.6092/1590-8577/608-615.
Matsuda H, Sadamori H, Umeda Y. Preventive effect of omental flap in pancreaticoduodenectomy against postoperative pseudoaneurysm formation. Hepato-gastroenterology. 2012; 59(115):578-83. DOI: 10.5754/hge115.578.
Xu C, Yang X, Luo X. Wrapping the gastroduodenal artery stump during pancreatoduodenectomy reduced the stump hemorrhage incidence after operation. Chinese Journal of Cancer Research. 2014; 26(3):299-308. DOI: 10.3978/j.issn.1000-9604.2014.05.08.
Maeda A, Ebata T, Kanemoto H. Omental flap in pancreaticoduodenectomy for protection of splanchnic vessels. World Journal of Surgery. 2005; 29(9):1122-26. DOI: 10.1007/s00268-005-0018-x.
Müssle B, Wierick A, Distler M. Falciform ligament wrap for prevention of gastroduodenal artery bleed after pancreatoduodenectomy. Journal of Surgical Research. 2017; 217:215-22. DOI: 10.1016/j.jss.2017.03.013.
Rosso E, Lopez P, Roedlich MN. Double omental flap reduced perianastomotic collections and relaparotomy rates after pancreaticoduodenectomy with pancreaticogastrostomy. World Journal of Surgery. 2012; 36(7):1672-78. DOI: 10.1007/s00268-012-1575-5.
Crown A, Helton S, Biehl T, Rocha F, Alseidi, A. Circumferential pedicled omental flap for protection of portomesenteric venous reconstruction and gastroduodenal artery stump following pancreatoduodenectomy. American journal of surgery. 2017; 213 (5):983. DOI: 10.1016/j.amjsurg.2017.03.033.
Yang H, Tian YH, Peng Y, Li G. Preventive effect of omental flap in pancreaticoduodenectomy against postoperative complications: a meta-analysis. Hepato-gastroenterology. 2015; 62(137):187-9.
Teng Y, Wang Y, Yang S, Nie G, Wen N, Zhang Y, et al. Surgery-related factors for pancreatic fistula after pancreatectomy: an umbrella review. Hepatobiliary Surg Nutr. 2025; 14(3):442-59. DOI: 10.21037/hbsn-23-601.
Bassi C, Marchegiani G, Dervenis C, Sarr M, Hilal MA, Adam JP, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula. Surgery. 2016; 161(3):584-91.
Deng S, Luo J, Ouyang Y, Xie J, He Z, Huang B, et al. Application analysis of omental flap isolation and modified pancreaticojejunostomy in pancreaticoduodenectomy (175 cases). BMC Surg. 2022; 22(1):127.
Tangtawee P, Mingphruedhi S, Rungsakulkij N, Suragul W, Vassanasiri W, Muangkaew P. Prospective randomized controlled trial of omental roll-up technique on pancreatojejunostomy anastomosis for reducing perioperative complication in patients undergoing pancreatoduodenectomy. J Hepatobiliary Pancreat Sci. 2021; 28(5):450-56.
Jayaratnam S, Tandup C, Sakaray YR, Kurdia KC, Gupta A, Kaman L. Efficacy of the omental roll-up technique in pancreaticojejunostomy to prevent postoperative pancreatic fistula after pancreaticoduodenectomy. Ann Hepatobiliary Pancreat Surg. 2024; 28:358-63.
Meza-Perez S, Randall TD. Immunological Functions of the Omentum. Trends Immunol. 2017; 38(7):526-36.
Bass GA, Seamon MJ, Schwab CW. A surgeon’s history of the omentum: From omens to patches to immunity. J Trauma Acute Care Surg. 2020; 89(6):e161-e166.
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