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RACS ASC 2024

What is the Influence of Gastroduodenal Artery Control Techniques on Post-Pancreatectomy Haemorrhage?

Verbal Presentation

Verbal Presentation

8:57 am

08 May 2024

Conway 3

RESEARCH PAPERS

Disciplines

HPB Surgery

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Institution: Fiona Stanley Hospital - Western Australia, Australia

Purpose: Post-pancreatectomy haemorrhage (PPH) is a complication of pancreaticoduodenectomy (PD), with a 20% mortality rate. PPH often arises from the gastroduodenal artery (GDA) due to its predisposition to enzymatic degradation from a post-operative pancreatic fistula (POPF). This study investigated GDA control techniques and PPH risk. Methodology: A retrospective cohort study was conducted on all PD patients from January 2022 to December 2023. Patient’s clinicopathological and technical data and outcomes were analysed using SPSS v.29. Results: Eighty-two patients underwent PD, of which 79% were classic. Males comprised 62%, with a median age of 68 (IQR14) and a median BMI of 25.3 (IQR6.8). The modified Blumgart technique was used for all pancreaticojejunostomies. GDA control was achieved via the application of any combination of Hem-o-lok® (57%), staples (40%), ties (36%), sutures (33%), and LIGACLIP® (15%). PPH rate was (12.2%), with a 20% mortality rate. PPH risk was significantly associated with POPF (p<.01). The PPH risk was higher in stapled GDAs; however, this was not statistically significant (17.2% vs 4.7%, p=0.110). The GDA was staple-controlled alone in 25% of cases, with an associated POPF rate of 24.1%. The PPH rate of stapled GDAs in the setting of a POPF was 42.9% (p=.07). However, no significant associations were reported for procedure type, surgeon, haemostatic agents, or other GDA control methods. Conclusion: This study identified an associated increased risk of PPH with stapled GDAs, especially in the setting of a POPF. While this trend did not reach statistical significance, this is a clinically important observation that requires further evaluation with an RCT.

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Dr Alexander Armanios - , Dr Munyaradzi Nyandoro - , Miss Nehel Syed - , Miss Sruthi Saravanan - , Dr Mandivavarira Maundura - , Prof Mohammed Ballal -