Arterial and anastomotic wrapping in pancreaticoduodenectomy as a strategy to reduce complications: a systematic review and meta-analysis

Abstract

Background: Pancreaticoduodenectomy is associated with high morbidity, with pancreatic fistulas and hemorrhages being the most dangerous complications. We performed a systematic review and meta-analysis to evaluate the efficacy of arterial and anastomotic wrapping in pancreaticoduodenectomy.

Methods: We searched PubMed, Embase, and Cochrane Central from inception to February 2024 for studies comparing omental or ligament flaps for arterial or pancreaticojejunostomy coverage in pancreaticoduodenectomies, evaluating common postoperative complications. Odds ratio (OR) was used for categorical variables and mean difference (MD) for continuous variables. We considered as significant p-values < 0.05.

Results: We included 15 studies, comprising 3232 patients. The intervention successfully reduced the rates of postpancreatectomy hemorrhage (OR 0.47; p < 0.001), with an additional reduction in postoperative pancreatic fistula when considering the use of omental wrapping (OR 0.48; p = 0.002). Delayed gastric emptying was not associated with a reduction when using the wrapping technique (OR 0.69; p = 0.06).

Conclusion: Our findings showed that the wrapping technique decreased the rate of major complications associated with pancreaticoduodenectomy without increasing operative time or reoperation rates.