Omental wrapping combined with external pancreatic drainage is associated with a lower incidence of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: a retrospective study.
- 1Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- 2Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China.
- 3The First People's Hospital of Jiashan County, Jiaxing, China.
Abstract
Postoperative pancreatic fistula (POPF) remains the most challenging complication following pancreaticoduodenectomy (PD), with clinically relevant POPF (CR-POPF) significantly impacting patient outcomes and healthcare resources. Although external pancreatic drainage and omental wrapping have each been explored for fistula prevention, their combined effect has not been well characterized. This study aimed to evaluate whether the combination of omental wrapping of the pancreaticojejunostomy with external pancreatic drainage reduces the incidence of CR-POPF after PD. We retrospectively analyzed 130 patients who underwent PD between January 2023 and June 2024. Patients were divided into three groups: control (n=55), external drainage alone (n=45), and external drainage with omental wrapping (n=30). Perioperative data and postoperative complications were compared across groups. Univariable and firth penalized logistic regression analyses were performed to identify independent factors associated with CR-POPF. The three groups were balanced in demographics, pancreatic texture, duct size, and fistula risk score (FRS). Compared with the control group, the omental wrapping group had significantly lower CR-POPF (6.7% vs. 34.5%, P=0.004) and abdominal effusion (23.3% vs. 52.7%, P=0.009). The external drainage-alone group showed no significant difference from controls in any complication. Multivariable analysis confirmed that external drainage with omental wrapping was an independent protective factor against CR-POPF [adjusted odds ratio (OR) =0.244, 95% confidence interval (CI): 0.061-0.980, P=0.047]. Combining omental wrapping with external pancreatic drainage was associated with a lower incidence of CR-POPF after PD, whereas external drainage alone was not. This simple technique may have clinical implications and requires validation in prospective randomized trials.
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BibTeX
@article{feng2026omental,
title = {{Omental wrapping combined with external pancreatic drainage is associated with a lower incidence of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: a retrospective study.}},
author = {Yihui Feng and Chunlong Shao and Shaoyan Xu and Weifeng Liu and Zhenzhen Gao and Yang Tian and Bo Zhou and Xiang Zheng and Guogang Li and Sheng Yan},
journal = {Gland surgery},
year = {2026},
month = sep,
doi = {10.21037/gs-2026-0437},
url = {https://europepmc.org/article/MED/42996555},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Omental wrapping combined with external pancreatic drainage is associated with a lower incidence of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: a retrospective study.
AU - Yihui Feng
AU - Chunlong Shao
AU - Shaoyan Xu
AU - Weifeng Liu
AU - Zhenzhen Gao
AU - Yang Tian
AU - Bo Zhou
AU - Xiang Zheng
AU - Guogang Li
AU - Sheng Yan
PY - 2026
DA - 2026/09/30
JO - Gland surgery
DO - 10.21037/gs-2026-0437
UR - https://europepmc.org/article/MED/42996555
AB - Postoperative pancreatic fistula (POPF) remains the most challenging complication following pancreaticoduodenectomy (PD), with clinically relevant POPF (CR-POPF) significantly impacting patient outcomes and healthcare resources. Although external pancreatic drainage and omental wrapping have each been explored for fistula prevention, their combined effect has not been well characterized. This study aimed to evaluate whether the combination of omental wrapping of the pancreaticojejunostomy with external pancreatic drainage reduces the incidence of CR-POPF after PD. We retrospectively analyzed 130 patients who underwent PD between January 2023 and June 2024. Patients were divided into three groups: control (n=55), external drainage alone (n=45), and external drainage with omental wrapping (n=30). Perioperative data and postoperative complications were compared across groups. Univariable and firth penalized logistic regression analyses were performed to identify independent factors associated with CR-POPF. The three groups were balanced in demographics, pancreatic texture, duct size, and fistula risk score (FRS). Compared with the control group, the omental wrapping group had significantly lower CR-POPF (6.7% vs. 34.5%, P=0.004) and abdominal effusion (23.3% vs. 52.7%, P=0.009). The external drainage-alone group showed no significant difference from controls in any complication. Multivariable analysis confirmed that external drainage with omental wrapping was an independent protective factor against CR-POPF [adjusted odds ratio (OR) =0.244, 95% confidence interval (CI): 0.061-0.980, P=0.047]. Combining omental wrapping with external pancreatic drainage was associated with a lower incidence of CR-POPF after PD, whereas external drainage alone was not. This simple technique may have clinical implications and requires validation in prospective randomized trials.
SN - 2227-684X
SN - 2227-8575
ER -