Usefulness of Hem-o-lok® clips to ligate the gastroduodenal artery in pancreatoduodenectomy

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-12-01 DOI:10.1016/j.hpb.2024.08.014

Norio Kubo , Shigemasa Suzuki , Takahiro Seki , Ryosuke Fukushima , Shunsaku Furuke , Naoki Yagi , Takashi Ooki , Ryusuke Aihara , Kenichiro Araki , Yasuo Hosouchi , Ken Shirabe

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引用次数: 0

Abstract

Background/purpose

Post-pancreatectomy hemorrhage (PPH) is a fatal complication of pancreatoduodenectomy. When complicated by a pancreatic fistula, pancreatic juice contacting the artery may form a pseudoaneurysm and cause arterial bleeding. We used Hem-o-lok® clips to prevent damage to the outer wall of the gastroduodenal artery (GDA). This study evaluated the usefulness of using Hem-o-lok® clips to ligate the GDA stump to prevent PPH.

Methods

Overall, 468 patients who underwent PD at our hospital were included. Before July 2020, we ligated the GDA stump using the knot-tying method, which involves double ligation. After July 2020, the GDA stump was double clipped using a 10-mm Hem-o-lok® clip to the residual side without tension on the GDA. Propensity score matching was used to compare cases of pancreatic fistulas that underwent clipping vs. knot-tying.

Results

Propensity score matching resulted in 37 patients in each group. PPH occurred in 12 (16.4%) and 4 (6.9%) patients in the knot-tying and clipping groups, respectively. PPH from the GDA stump occurred in eight (11.0%) and one (1.7%) patient in the knot tying and clipping groups, respectively (P = 0.044).

Conclusions

Hem-o-lok® clips are safe to apply on the GDA stump during pancreatoduodenectomy to prevent PPH.

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Hem-o-lok® 夹在胰十二指肠切除术中结扎胃十二指肠动脉的实用性

胰腺切除术后出血（PPH）是胰十二指肠切除术的一种致命并发症。当并发胰瘘时，胰液接触动脉可能形成假性动脉瘤，导致动脉出血。我们使用 Hem-o-lok® 夹来防止胃十二指肠动脉（GDA）外壁受损。本研究评估了使用 Hem-o-lok® 夹结扎胃十二指肠动脉残端以预防 PPH 的实用性。本研究共纳入了 468 名在我院接受腹腔镜手术的患者。2020 年 7 月之前，我们使用打结法结扎 GDA 残端，即使用丝线进行双重结扎。2020 年 7 月之后，我们使用 10 毫米 Hem-o-lok® 夹将 GDA 残端双夹至残留侧，但不对 GDA 施加张力。采用倾向得分匹配法对胰瘘病例进行剪切与打结的比较。倾向评分匹配的结果是每组各有 37 名患者。打结组和剪切组分别有 12 例（16.4%）和 4 例（6.9%）患者发生 PPH。打结组和剪切组分别有 8 名（11.0%）和 1 名（1.7%）患者发生来自 GDA 残端的 PPH（P=0.044）。Hem-o-lok® 夹在胰十二指肠切除术中应用于 GDA 残端以预防 PPH 是安全的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).