Techniques for falciform/round ligament wrapping and omental flap application for gastroduodenal artery stump and mesenteric vessel management during pancreaticoduodenectomy to prevent clinically relevant delayed post-pancreatectomy hemorrhage: a step-by-step guide with video

We present a step-by-step guide with video of the wrapping technique using an omental flap and a falciform/round ligament wrap during pancreatectomy to prevent the risk of clinically relevant delayed grade C post-pancreatectomy hemorrhage (CR-PPH) secondary to postoperative pancreatic fistula (POPF). The aim is to separate the skeletonized hepatic pedicle, retroperitoneal vessel, and vascular stump from the pancreatic anastomosis to prevent pancreatic fluid vessel exposure. A total of 13 patients benefited from this double-wrapping technique between April 2023 and July 2024 in our tertiary center. Only one patient developed a late grade C PPH. The retroperitoneal packing technique can reduce the severity of late pancreatic hemorrhage after duodenopancreatectomy.

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