Usefulness of Hem-o-lok® clips to ligate the gastroduodenal artery in pancreatoduodenectomy

• Published in: HPB (Oxford, England)
• Main Authors: Kubo, Norio, Suzuki, Shigemasa, Seki, Takahiro, Fukushima, Ryosuke, Furuke, Shunsaku, Yagi, Naoki, Ooki, Takashi, Aihara, Ryusuke, Araki, Kenichiro, Hosouchi, Yasuo, Shirabe, Ken
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 03.09.2024
• ISSN: 1365-182X; 1477-2574; 1477-2574
• DOI: 10.1016/j.hpb.2024.08.014

Post-pancreatectomy hemorrhage (PPH) is a fatal complication of pancreatoduodenectomy. When complicated by a pancreatic fistula, pancreatic juice contacting the artery may form a pseudoaneurysm and cause arterial bleeding. We used Hem-o-lok® clips to prevent damage to the outer wall of the gastroduodenal artery (GDA). This study evaluated the usefulness of using Hem-o-lok® clips to ligate the GDA stump to prevent PPH. Overall, 468 patients who underwent PD at our hospital were included. Before July 2020, we ligated the GDA stump using the knot-tying method, which involves double ligation. After July 2020, the GDA stump was double clipped using a 10-mm Hem-o-lok® clip to the residual side without tension on the GDA. Propensity score matching was used to compare cases of pancreatic fistulas that underwent clipping vs. knot-tying. Propensity score matching resulted in 37 patients in each group. PPH occurred in 12 (16.4%) and 4 (6.9%) patients in the knot-tying and clipping groups, respectively. PPH from the GDA stump occurred in eight (11.0%) and one (1.7%) patient in the knot tying and clipping groups, respectively (P = 0.044). Hem-o-lok® clips are safe to apply on the GDA stump during pancreatoduodenectomy to prevent PPH.