Packing of the Gastroduodenal Artery Stump Using Falciform Ligament During Pancreaticoduodenectomy

Background/Aim: Pseudoaneurysm formation is a potentially fatal complication after pancreaticoduodenectomy. We developed a packing method in which the gastroduodenal artery stump is packed inside a falciform ligament to reduce the post-pancreatectomy hemorrhage due to pseudoaneurysm formation. This study aimed to evaluate its efficacy. Patients and Methods: This study included 210 patients who underwent pancreaticoduodenectomies between January 2007 and December 2023. The study population was divided into two groups; the packing group (n=110) and the no-packing group (n=100), and the clinical variables were compared between the two groups. Results: Pseudoaneurysms were observed in six (2.9%) patients, and post-pancreatectomy hemorrhage was observed in four (1.9%) patients. There was no significant difference in pseudoaneurysm formation between the packing and no-packing groups (p=0.477), and the mortality rates for both pseudoaneurysm and postpancreatectomy hemorrhage were zero. Two patients in the no-packing group were found to have shock, whereas four patients in the packing group (n=4) did not. Additionally, we encountered a 6 cm unruptured pseudoaneurysm following packing. Conclusion: The packing method did not reduce pseudoaneurysm formation after pancreaticoduodenectomy, but may prevent pseudoaneurysm rupture.