Ligamentum teres hepatis wrapping of the gastroduodenal artery stump protection in total laparoscopic pancreaticoduodenectomy: a single-center experience

Background: Stump hemorrhage of the gastroduodenal artery (GDA) is a significant postoperative risk of pancreaticoduodenectomy (PD). We determined whether wrapping the GDA stump with the ligamentum teres hepatis (LTH) would reduce postoperative pancreaticoduodenal bleeding. Methods We retrospectively reviewed 148 patients who underwent laparoscopic pancreatoduodenectomy (LPD) at Li Huili Hospital of Ningbo Medical Center from November 2015 to September 2021. We compared perioperative data from 63 LPD patients without wrapping of the GDA (the unwrapped group) and 85 whose GDA stumps were wrapped (the wrapping group). Results There was no significant difference in the groups' baseline characteristics. The postoperative GDA stump bleeding incidence was significantly lower in the wrapped group than in the unwrapped group (7.9% vs. 0% p = 0.013). There was no significant difference in the incidence of other complications (e.g., intraabdominal infection, pancreatic fistula, biliary fistula, and gastrointestinal bleeding). Conclusions Using the LTH to wrap the GDA stump during LPD can reduce bleeding from the GDA stump but not the incidence of other complications.