Wrapping of skeletonized and divided vessels using the falciform ligament in distal pancreatectomy

BackgroundA pancreatic fistula is a major cause of morbidity in patients undergoing distal pancreatectomy (DP). A pancreatic fistula may expose skeletonized or divided vessels directly to pancreatic juice, creating a setting for vessel erosion and delayed intra-abdominal hemorrhage (DIH). With the aim of protecting vessels near the pancreatic stump from potential pancreatic fistulas, we have adopted a surgical option by which these vessels are wrapped using a pedicled falciform ligament.MethodsAfter completing DP, the pedicled falciform ligament is spread out widely on major vessels exposed during resection near the pancreatic stump, and fixed to the surrounding retroperitoneal connective tissue. These procedures allow the complete separation of these vessels from the pancreatic stump. We reviewed the cases of 8 patients who underwent DP including these procedures.ResultsThe mobilization of the falciform ligament and the wrapping of the vessels were successfully performed without any complications. Although 2 patients (14.5%) developed pancreatic fistulas, DIH did not occur in any of the patients.ConclusionsThe wrapping of the skeletonized and divided vessels using a pedicled falciform ligament is simple and easy, and may be an effective prophylactic measure against DIH following DP.