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. 2018 Apr 12;19(1):222.
doi: 10.1186/s13063-018-2580-0.

Pancreatoduodenectomy with or without prophylactic falciform ligament wrap around the gastroduodenal artery stump for prevention of pancreatectomy hemorrhage

Benjamin Müssle  1 , Leonie Zühlke  1 , Ann Wierick  1 , Dorothée Sturm  1 , Xina Grählert  2 , Marius Distler  1 , Nuh N Rahbari  1 , Jürgen Weitz  1 , Thilo Welsch  3
Affiliations

Pancreatoduodenectomy with or without prophylactic falciform ligament wrap around the gastroduodenal artery stump for prevention of pancreatectomy hemorrhage

Benjamin Müssle et al. Trials. .

Abstract

Background: The purpose of this study is to evaluate whether wrapping of the pedicled falciform ligamentum flap around the gastroduodenal artery (GDA) stump/hepatic artery can significantly decrease the incidence of erosion hemorrhage after pancreatoduodenectomy (PD).

Methods/design: This is a randomized controlled multicenter trial involving 400 patients undergoing PD. Patients will be randomized into two groups. The intervention group consists of 200 patients with a prophylactic wrapping of the GDA stump using the pedicled falciform ligament. The control group consists of 200 patients without the wrap. The primary endpoint is the rate of postoperative erosion hemorrhage of the GDA stump or hepatic artery within 3 months. The secondary endpoints are postpancreatectomy hemorrhage stratified according to the texture of the pancreas, postoperative pancreatic fistula (POPF), postoperative rate of therapeutic interventions, morbidity, and mortality.

Discussion: Only few retrospective studies investigated the effectiveness of a falciform ligament wrap around the GDA for prevention of erosion hemorrhage. Erosion hemorrhage occurs in up to 6-9% of cases after PD and is most frequently evoked by a POPF. Erosion hemorrhage is associated with a remarkable mortality of over 30%. The rate of hemorrhage after performing the wrap is reported to be low. However, there exist no prospectively controlled data to support its general use. Therefore, the presented randomized controlled trial will provide clinically relevant evidence of the effectiveness of the wrap with statistical significance.

Trial registration: clinicaltrials.gov, NCT02588066 ; Registered on 27 October 2015.

Keywords: Falciform ligament; Gastroduodenal artery; Hemorrhage; Pancreatic fistula; Pancreatoduodenectomy.

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Conflict of interest statement

Ethics approval and consent to participate

The clinical trial is conducted in line with the Declaration of Helsinki. The study protocol was approved by the local ethical committee at the TU Dresden, Germany (decision number EK225062016). All patients have to be informed about the trial and to give the written informed consent.

Consent for publication

We declare to publish the results of the described clinical trial.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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