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Pancreatoduodenectomy in which dissection of the efferent arteries of the head of the pancreas is performed first
Author(s) -
Horiguchi Akihiko,
Ishihara Shin,
Ito Masahiro,
Nagata Hideo,
Shimizu Tomohiro,
Furusawa Koichi,
Kato Ryoichi,
Katada Kazuhiro,
Miyakawa Shuichi
Publication year - 2007
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-006-1198-x
Subject(s) - efferent , dissection (medical) , medicine , pancreas , head (geology) , anatomy , pancreatic head , radiology , afferent , biology , paleontology
Background/Purpose Pancreatoduodenectomy (PD) is one of the most difficult operations in gastrointestinal surgery. Standard PD ligates and cuts superior mesenteric vein (SMV) branches after the removal of the pancreas head, which leads to congestion and bleeding of these veins. Methods In this study, we modified the standard PD and first ligated the efferent vessels (arteries); namely, the gastroduodenal artery and inferior pancreatoduodenal artery (IPDA), before ligating and cutting the corresponding afferent vessels (veins) of the pancreas head. By doing this, congestion of these veins was relieved and bleeding from the resected surface was substantially prevented. Thirty‐six patients (18 underwent standard PD and 18 had modified PD) formed the study population. Results The amount of bleeding in the modified PD group was significantly lower than that in the standard PD group. (678 ± 329 g vs 1225 ± 375 g, respectively; P < 0.05) However, no difference in operation time was found between the two groups. Conclusions We believe this modified PD procedure is valuable to enable the safe performance of PD.