THE IMPACT OF USING AN OMENTAL FLAP IN THE FORMATION OF PANCREATICOJEJUNOSTOMY ON POSTOPERATIVE INFLAMMATORY RESPONSE
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i2.15318Keywords:
pancreaticoduodenectomy, omental flap, postoperative complications, inflammatory response, interleukin-6, C-reactive protein, leukocytesAbstract
SUMMARY. The aim – to evaluate the impact of using an omental flap in the formation of pancreaticojejunostomy on postoperative inflammatory response. The focus was on reducing the incidence of postoperative complications and inflammatory activity by analyzing the dynamics of key inflammatory markers, including C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and leukocyte levels.
Material and Methods. A prospective study was conducted involving patients who underwent pancreaticoduodenectomy (PD) at the National Scientific Center of Surgery and Transplantology named after O.O. Shalimov between January 2023 and December 2024. The study included 68 patients divided into two groups. In the main group (n=36), PD was performed using an omental flap covered with an elastic pad treated with pentaerythritol-polyethylene glycol ether. The control group (n=32) underwent PD without the omental flap. Specific inflammatory markers were analyzed dynamically: preoperatively and on postoperative days 1, 3, and 7. Data were processed using nonparametric statistical methods, including the Mann-Whitney U-test and Friedman test. Trend analysis was employed to evaluate marker changes over time.
Results. The results showed that patients in the main group had significantly lower levels of CRP, IL-6, PCT, and leukocytes compared to the control group at all time points. Specifically, IL-6 levels in the main group decreased by 30 % on postoperative day 1 compared to the control group (p<0.001), indicating early suppression of pro-inflammatory activity. CRP levels on postoperative day 7 were on average 32.43 mg/L lower in the main group, confirming the sustained anti-inflammatory effect of the omental flap (p<0.001). Similarly, leukocyte levels in the main group decreased by 35 % (p<0.001), demonstrating effective regulation of the systemic inflammatory response.
Regression analysis confirmed the significant impact of the omental flap on reducing inflammatory markers, with high coefficients of determination (R² >0.7). Sensitivity analysis demonstrated the robustness of the findings, even after excluding outliers.
The findings align with contemporary studies that validate the effectiveness of the omental flap in reducing the incidence of postoperative complications and inflammatory activity. However, limitations of the study include a relatively small sample size and a lack of long-term follow-up.
Conclusions. The use of the omental flap in pancreaticoduodenectomy significantly reduces the incidence of postoperative complications and systemic inflammatory response. This approach demonstrates a stable anti-inflammatory effect, as evidenced by reduced levels of CRP, IL-6, and leukocytes. The results highlight the efficacy of the omental flap as an essential component of a comprehensive surgical treatment strategy for pancreatic diseases. Further research is needed to explore the molecular mechanisms of its action and determine optimal clinical indications for its use.
References
Andreasi V, Partelli S, Crippa S, Balzano G, Tamburrino D, Muffatti F, et al. 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. DOI: https://doi.org/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. DOI: https://doi.org/10.1016/j.surg.2011.07.023
Shah OJ, Bangri SA, Singh M. Omental flaps reduce complications after pancreaticoduodenectomy. Hepatobiliary Pancreat Dis Int. 2015;14(3):313–9. DOI: 10.1016/S1499-3872(15)60372-1. DOI: https://doi.org/10.1016/S1499-3872(15)60372-1
Kapoor VK, Behari A, Singh RK, Kumar A. Omental flaps in pancreaticoduodenectomy. JOP. 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. Hepatogastroenterology. 2012;59(115):578–83. DOI: 10.5754/hge115.578. DOI: https://doi.org/10.5754/hge11452
Xu C, Yang X, Luo X. Wrapping the gastroduodenal artery stump during pancreatoduodenectomy reduced the stump hemorrhage incidence after operation. Chin J Cancer Res. 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 J Surg. 2005;29(9):1122–6. DOI: 10.1007/s00268-005-0018-x. DOI: https://doi.org/10.1007/s00268-005-7900-3
Müssle B, Wierick A, Distler M. Falciform ligament wrap for prevention of gastroduodenal artery bleed after pancreatoduodenectomy. J Surg Res. 2017;217:215–22. DOI: 10.1016/j.jss.2017.03.013. DOI: https://doi.org/10.1016/j.jss.2016.08.087
Rosso E, Lopez P, Roedlich MN. Double omental flap reduced perianastomotic collections and relaparotomy rates after pancreaticoduodenectomy with pancreaticogastrostomy. World J Surg. 2012;36(7):1672–8. DOI: 10. 1007/s00268-012-1575-5. DOI: https://doi.org/10.1007/s00268-012-1546-8
Zhang L, Chen J, Wang Y. Surgical outcomes after pancreaticoduodenectomy: results from a 15-center study. Surg Today. 2022;52(6):891–900. DOI: 10.1007/s00595-022-02539-1.
Wang H, Li Y, Chen X. Advanced techniques in pancreaticoduodenectomy: a multicenter study of 1200 cases. Surg Endosc. 2023;37(1):234–43. DOI: 10.1007/s00464-022-09678-4.
Chen Y, Wang L, Liu X, Zhang H. Long-term outcomes after pancreaticoduodenectomy with omental flap wrapping: A meta-analysis of 2500 cases. J Surg Res. 2022;270:45–52. DOI: 10.1016/j.jss.2022.01.012. DOI: https://doi.org/10.1016/j.jss.2022.01.012
Jayaratnam S, et al. Efficacy of the omental roll-up technique in pancreaticojejunostomy to prevent postoperative pancreatic fistula after pancreaticoduodenectomy. Ann Hepatobiliary Pancreat Surg. 2024. DOI: 10.14701/ahbps.24-016. DOI: https://doi.org/10.14701/ahbps.24-016
Lima MM, Santos RS, Costa WL. Comprehensive analysis of pancreaticoduodenectomy techniques: a meta-analysis. HPB. 2021;23(8):1156–65. DOI: 10.1016/j.hpb.2021.03.007. DOI: https://doi.org/10.1016/j.hpb.2021.03.007
