Wrapping of the Gastroduodenal Artery Stump to Reduce Haemorrhage After Pancreaticoduodenectomy

Abstract

Pancreaticoduodenectomy (PD) is a complex and high-risk surgical procedure associated with significant morbidity and mortality, particularly due to post-pancreatectomy haemorrhage (PPH). Wrapping the gastroduodenal artery stump (GDAS) intraoperatively has been proposed as a preventive measure, utilizing various materials such as the falciform ligament (FL), ligamentum teres hepatis (LTH), omentum, and polyglycolic acid (PGA) sheets. A comprehensive meta-analysis was conducted, including 10 studies involving 3,398 participants. Comparative studies were selected to evaluate the risk of PPH with GDAS wrapping versus control groups. Odds ratios (ORs) were used to assess efficacy. GDAS wrapping significantly reduced PPH incidence (OR = 0.23, 95% CI: 0.11-0.51), despite high heterogeneity among studies (I² = 64%). Subgroup analysis showed significant reductions with FL/LTH (OR = 0.20, p = 0.003) and PGA (OR = 0.18, p = 0.007) but not with omental (OR = 0.37, p = 0.07). The analysis of 30-day mortality did not reach significance (OR = 0.76, p = 0.44). GDAS wrapping may reduce PPH risk; however, further randomised studies are needed to confirm these findings and assess the superiority of specific wrapping techniques.