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Omental flap wrapping with fixation to the cut surface of the liver for reducing delayed gastric emptying after left-sided hepatectomy

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Abstract

Background

Delayed gastric emptying (DGE) is a common complication following left-sided hepatectomy. The goal of this study was to clarify the clinical implications of an omental flap wrapping procedure that includes fixation to the cut surface of the liver to reduce the incidence of DGE after left-sided hepatectomy.

Methods

The study included 50 consecutive patients who underwent left-sided hepatectomy between January 2000 and July 2011. Clinicopathologic risk factors for DGE after left-sided hepatectomy were identified using univariate and multivariate models. The incidence of DGE, digestive symptoms, and postoperative complications were compared between two groups: 25 patients treated with the omental flap wrapping and fixation procedure and 25 patients who did not receive such a flap.

Results

A univariate analysis revealed that a lack of the omental flap, the lymph node clearance, and use of left hemihepatectomy were associated with postoperative DGE. The multivariate analysis indicated that the lack of the omental flap was the only independent significant factor associated with the DGE (odds ratio, 21.23; p = 0.0002). There was a significant difference in the incidence of DGE between the patients with (4 %) and without an omental flap (36 %). The incidence of gastric distension and the use of prokinetic drugs were also significantly lower in patients with an omental flap than in patients without the flap, and patients with an omental flap resumed a solid diet significantly earlier.

Conclusions

This retrospective single-center study revealed that it was possible to reduce the incidence of DGE using a procedure involving omental flap wrapping with fixation to the cut surface of the liver after left-sided hepatectomy.

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References

  1. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8.

    Article  PubMed  Google Scholar 

  2. Igami T, Nishio H, Ebata T, Yokoyama Y, Sugawara G, Nagino M. Using the greater omental flap to cover the cut surface of the liver for prevention of delayed gastric emptying after left-sided hepatobiliary resection: a prospective randomized controlled trial. J Hepatobiliary Pancreat Sci. 2011;18:176–83.

    Article  PubMed  Google Scholar 

  3. Oida T, Mimatsu K, Kawasaki A, Kanou H, Kuboi Y, Amano S. Fixation of the round ligament to the peritoneum and wrapping of the cut surface of the liver for prevention of early delayed gastric emptying after hepatic lateral segmentectomy. Langenbecks Arch Surg. 2010;395:655–9.

    Article  PubMed  Google Scholar 

  4. Umeshita K, Fujiwara K, Kiyosawa K, Makuuchi M, Satomi S, Sugimachi K, Tanaka K, et al. Operative morbidity of living liver donors in Japan. Lancet. 2003;362:687–90.

    Article  PubMed  Google Scholar 

  5. Yoshida H, Mamada Y, Taniai N, Mizuguchi Y, Shimizu T, Kakinuma D, Ishikawa Y, et al. Fixation of the greater omentum for prevention of delayed gastric emptying after left hepatectomy with lymphadenectomy for cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2007;14:392–6.

    Article  PubMed  Google Scholar 

  6. Yoshida H, Mamada Y, Taniai N, Mizuguchi Y, Shimizu T, Takahashi T, Akimaru K, et al. Fixation of the greater omentum for prevention of delayed gastric emptying after left-sided hepatectomy: a randomized controlled trial. Hepatogastroenterology. 2005;52:1334–7.

    PubMed  Google Scholar 

  7. Nakamura M, Kido Y, Egawa T. Development of a 32-item scale to assess postoperative dysfunction after upper gastrointestinal cancer resection. J Clin Nurs. 2008;17:1440–9.

    Article  PubMed  Google Scholar 

  8. Nakamura M, Kido Y, Yano M, Hosoya Y. Reliability and validity of a new scale to assess postoperative dysfunction after resection of upper gastrointestinal carcinoma. Surg Today. 2005;35:535–42.

    Article  PubMed  Google Scholar 

  9. Park JS, Hwang HK, Kim JK, Cho SI, Yoon DS, Lee WJ, Chi HS. Clinical validation and risk factors for delayed gastric emptying based on the International Study Group of Pancreatic Surgery (ISGPS) Classification. Surgery. 2009;146:882–7.

    Article  PubMed  Google Scholar 

  10. Welsch T, Borm M, Degrate L, Hinz U, Buchler MW, Wente MN. Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre. Br J Surg. 2010;97:1043–50.

    Article  PubMed  CAS  Google Scholar 

  11. Liebermann-Meffert D. The greater omentum. Anatomy, embryology, and surgical applications. Surg Clin North Am. 2000;80:275–93, xii.

    Google Scholar 

  12. von Planta M, Ozsahin H, Schroten H, Stauffer UG, Seger RA. Greater omentum flaps and granulocyte transfusions as combined therapy of liver abscess in chronic granulomatous disease. Eur J Pediatr Surg. 1997;7:234–6.

    Article  Google Scholar 

  13. Ye QF, Niu Y, She XG, Ming YZ, Cheng K, Ma Y, Ren ZH. Pedicled greater omentum flap for preventing bile leak in liver transplantation patients with poor biliary tract conditions. Hepatobiliary Pancreat Dis Int. 2007;6:470–3.

    PubMed  Google Scholar 

  14. Maeda A, Ebata T, Kanemoto H, Matsunaga K, Bando E, Yamaguchi S, Uesaka K. Omental flap in pancreaticoduodenectomy for protection of splanchnic vessels. World J Surg. 2005;29:1122–6.

    Article  PubMed  Google Scholar 

  15. Saber AA, Jackson O. Omental wrap: a simple technique for reinforcement of the gastrojejunostomy during Roux-en-Y gastric bypass. Obes Surg. 2007;17:15–8.

    Article  PubMed  Google Scholar 

  16. Kinoshita A, Takatsuki M, Hidaka M, Soyama A, Eguchi S, Kanematsu T. Prevention of gastric stasis by omentum patching after living donor left hepatectomy. Surg Today. 2012;42:816–8.

    Article  PubMed  Google Scholar 

  17. Hao XY, Yang KH, Guo TK, Ma B, Tian JH, Li HL. Omentoplasty in the prevention of anastomotic leakage after colorectal resection: a meta-analysis. Int J Colorectal Dis. 2008;23:1159–65.

    Article  PubMed  Google Scholar 

  18. Gypen BJ, Hubens GJ, Hartman V, Balliu L, Chapelle TC, Vaneerdeweg W. Perforated duodenal ulcer after laparoscopic gastric bypass. Obes Surg. 2008;18:1644–6.

    Article  PubMed  Google Scholar 

  19. Gourgiotis S, Stratopoulos C, Moustafellos P, Dimopoulos N, Papaxoinis G, Vougas V, Hadjiyannakis E. Surgical techniques and treatment for hepatic hydatid cysts. Surg Today. 2007;37:389–95.

    Article  PubMed  Google Scholar 

  20. Nosotti M, Cioffi U, De Simone M, Mendogni P, Palleschi A, Rosso L, Ciulla MM, et al. Omentoplasty and thoracoplasty for treating postpneumonectomy bronchopleural fistula in a patient previously submitted to aortic prosthesis implantation. J Cardiothorac Surg. 2009;4:38.

    Article  PubMed  Google Scholar 

  21. Miyazaki M, Itoh H, Ambiru S, Shimizu H, Togawa A, Shiobara M, Shimizu Y, et al. Omental packing for the transected surface remnant liver after major hepatectomy. J Hepatobiliary Pancreat Surg. 1996;3:495–7.

    Article  Google Scholar 

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Conflict of interest

Keiichi Okano and co-authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan

    Keiichi Okano, Eisuke Asano, Minoru Oshima, Naoki Yamamoto, Shinichi Yachida, Yuji Nishizawa, Shintaro Akamoto, Masao Fujiwara & Yasuyuki Suzuki

  2. Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan

    Akihiro Deguchi, Hirohito Mori & Tsutomu Masaki

Authors
  1. Keiichi Okano
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  2. Eisuke Asano
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  3. Minoru Oshima
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  4. Naoki Yamamoto
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  5. Shinichi Yachida
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  6. Yuji Nishizawa
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  7. Shintaro Akamoto
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  8. Masao Fujiwara
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  9. Akihiro Deguchi
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  10. Hirohito Mori
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  11. Tsutomu Masaki
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  12. Yasuyuki Suzuki
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Correspondence to Keiichi Okano.

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Okano, K., Asano, E., Oshima, M. et al. Omental flap wrapping with fixation to the cut surface of the liver for reducing delayed gastric emptying after left-sided hepatectomy. Surg Today 43, 1425–1432 (2013). https://doi.org/10.1007/s00595-012-0446-8

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  • DOI: https://doi.org/10.1007/s00595-012-0446-8

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