Zhonghua Wai Ke Za Zhi. 2026 Aug 1;64(8):893-903. doi: 10.3760/cma.j.cn112139-20260223-00075.

ABSTRACT

Objective: To evaluate the safety and efficacy of wrapping the skeletonized hepatic artery and gastroduodenal artery (GDA) stump with a bovine pericardial patch during laparoscopic pancreaticoduodenectomy (LPD) for the prevention of delayed postpancreatectomy hemorrhage. Methods: This retrospective cohort study included 217 patients who underwent LPD at the Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, between June 2020 and February 2025. There were 135 male and 82 female patients, with an age of (63±13) years (range: 13 to 90 years). According to whether a bovine pericardial patch was used intraoperatively to wrap the hepatic artery and GDA stump, the patients were divided into a patch group (n=109) and a control group (n=108). Perioperative outcomes, postoperative complications, and follow-up results were compared between the two groups using the independent samples t-test, Mann-Whitney U test, repeated measures ANOVA, Pearson χ² test, or Fisher’s exact test. Univariate and multivariate Logistic regression analyses were performed to identify factors associated with delayed hemorrhage. Results: There were no significant between-group differences in postoperative complications(all P>0.05), including clinically relevant postoperative pancreatic fistula (19.3%(21/109) vs. 22.2%(24/108)), bile leak (5.5%(6/109) vs. 0.9%(1/108)), delayed gastric emptying (1.8%(2/109) vs. 0), and intra-abdominal infection (3.7%(4/109) vs. 5.6%(6/108)). Delayed PPH occurred in 4 patients(3.7%) in the patch group and 12 patients (11.1%) in the control group (P=0.041). GDA stump bleeding occurred in 1 patient(0.9%) in the patch group and 8 patients(7.4%) in the control group (P=0.019). Multivariate logistic regression analysis identified patch wrapping as an independent protective factor against delayed postpancreatectomy hemorrhage (PPH) (OR=0.206, 95%CI:0.055 to 0.768, P=0.019), whereas clinically relevant postoperative pancreatic fistula was an independent risk factor (OR=16.623, 95%CI:4.759 to 48.061, P<0.01). Conclusion: Wrapping the hepatic artery and GDA stump with a bovine pericardial patch during LPD can significantly reduce delayed PPH, particularly GDA stump bleeding, without increasing major perioperative complications, and appears to be a safe and effective preventive strategy.

PMID:42350894 | DOI:10.3760/cma.j.cn112139-20260223-00075