Arterial Reinforcement following Pancreatoduodenectomy: The Solution to Prevent Delayed Hemorrhage Caused by Postoperative Pancreatic Fistula.

PURPOSE
Delayed hemorrhage (DH) is a rare and yet well-known fatal complication associated with postoperative pancreatic fistula (POPF) in pancreatoduodenectomy (PD). The study aimed to investigate whether arterial reinforcement (AR) using polyglycolic acid sheets (PAS) followed by fibrin sealant (FS) to the hepatic artery could prevent DH in the setting of POPF after PD.


METHODS
A total of 345 patients underwent PD for periampullary tumors from March 2011 to March 2022. From March 2011 to March 2018, 225 patients underwent PD, and AR was not performed (non-AR group). From April 2018 to March 2022, 120 patients underwent PD, and AR was performed (AR group). AR was achieved by wrapping the proper hepatic artery all the way down to the celiac artery with PAS followed by coating with FS. Demographic profile and various outcomes including DH of these two groups were compared and analyzed retrospectively.


RESULTS
In non-AR group, 48 (21.3%) and 12 (5.3%) patients had grade B and C POPF respectively. In AR group, 26 (21.7%) and 4 (3.3%) patients had grade B and C POPF respectively. The incidence of POPF was not was not statistically significant (p = 0.702) between the groups. Among the patients with grade B or C POPF, DH occurred in 14 (23.3%) patients in non-AR group and only one patient in AR group (p = 0.016). Of the 15 patients with DH, four (26.7%) patients died.


CONCLUSION
AR using PAS and FS is effective in preventing DH in the setting of POPF.