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Guilbaud T, Faust C, Picaud O, Baumstarck K, Vicenty T, Farvacque G, Vanbrugghe C, Berdah S, Moutardier V, Birnbaum DJ. The falciform/round ligament "flooring," an effective method to reduce life-threatening post-pancreatectomy hemorrhage occurrence. Langenbecks Arch Surg 2023; 408:192. [PMID: 37171647 DOI: 10.1007/s00423-023-02915-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Late post-pancreatectomy hemorrhage (PPH) represents the most severe complication after pancreatic surgery. We have measured the efficacy of major vessels "flooring" with falciform/round ligament to prevent life-threatening grade C late PPH after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP). METHODS All consecutive patients who underwent PD and DP between 2013 and 2021 were retrospectively reviewed on a prospectively maintained database. The cohort was divided in two groups: "flooring" vs. "no flooring" method group. The "no flooring" group had omental flap interposition. Patient characteristics and operative and postoperative data including clinically relevant postoperative pancreatic fistula (CR-POPF), late PPH (grade B and C), and 90-day mortality were compared between the two groups. RESULTS Two hundred and forty patients underwent pancreatic resections, including 143 PD and 97 DP. The "flooring" method was performed in 61 patients (39 PD and 22 DP). No difference was found between the two groups concerning severe morbidity, CR-POPF, delayed PPH, and mortality rate. The rate of patients requiring postoperative intensive care unit was lower in the "flooring" than in the "no flooring" method group (11.5% vs. 25.1%, p = 0.030). Among patients with grade B/C late PPH (n = 30), the rate of life-threatening grade C late PPH was lower in the "flooring" than in the "no flooring" method group (28.6% (n = 2/7) vs. 82.6% (n = 19/24), p = 0.014). Risk factor analysis showed that the "flooring" method was the only protective factor against grade C late PPH occurrence (p = 0.013). CONCLUSION The "flooring" method using the falciform/round ligament should be considered during pancreatectomies to reduce the occurrence of life-threatening grade C late PPH.
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Affiliation(s)
- Théophile Guilbaud
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Cindy Faust
- Center of Epidemiology and Health Economy, Direction de La Recherche en Santé, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Olivier Picaud
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Karine Baumstarck
- Center of Epidemiology and Health Economy, Direction de La Recherche en Santé, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Thibaud Vicenty
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Georges Farvacque
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Charles Vanbrugghe
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Stéphane Berdah
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Vincent Moutardier
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - David Jérémie Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France.
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Vicenty T, Zoratti V, Ravaud S, Birnbaum DJ. Small bowel obstruction after laparoscopic adjustable gastric band: The gastric band is not always the one involved. Surgery 2022; 172:e37-e38. [PMID: 35501196 DOI: 10.1016/j.surg.2022.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Thibaud Vicenty
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, France
| | - Valentina Zoratti
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, France
| | - Simon Ravaud
- Department of Radiology, Hôpital Nord, Aix-Marseille Université, France
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Vicenty T, Tradi F, Haffner A, Mege D. Unusual abdominal pain: A mesenteric plexiform neurofibroma. ANZ J Surg 2021; 92:900-901. [PMID: 34473877 DOI: 10.1111/ans.17186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/08/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Thibaud Vicenty
- Department of Digestive Surgery, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
| | - Farouk Tradi
- Department of Radiology, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
| | - Aurélie Haffner
- Department of Pathology, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille University, APHM, Timone University Hospital, Marseille, France
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