IDDF2018-ABS-0242 Sleeve omentopexy over pancreatico jejunostomy – a new technique

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Abstract

Background

Pancreatic anastomotic leak is considered as one of the most feared complications of Whipple’s procedure. We developed a novel technique of pancreaticojejunostomy. With the use of this technique, there was no pancreatic anastomotic leak and very low rate of bleeding complications.

Methods

This technique was used in 18 patients with periampullary carcinoma who underwent pancreaticoduodenectomy from December 2016 to Jan 2018. Pancreaticojejunostomy was done using standard Blumgart’s technique. The anastomotic line was covered all around by a sleeve of omentum. Preoperative and intraoperative characteristics of the patients were recorded. Postoperative complications were monitored.

Results

We used this technique in 18 patients. The median preoperative bilirubin and serum protein were 2.45 mg/dl and 7.1 gm/dl respectively. Ten patients had obstructive jaundice. Of which four patients had a history of preoperative CBD stenting. Median main pancreatic duct diameter was 3 mm. The mean operating time was 5 hours and 30 min. There was no postoperative pancreatic leak. No patient had a bleeding complication. Two patients had a hepaticojejunostomy leak, which were managed conservatively. The Median postoperative hospital stay was 16 days. There was no mortality related to the pancreatic leak.

Conclusions

Sleeve omentopexy is a very simple technique without any added cost. This procedure hardly adds to the operative time. Till now this technique has markedly reduced pancreatic leak and bleeding-related complications in our department. As we grow our experience with this technique in more and more patients, we can come up with some robust data.

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