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S uperior mesenteric artery first approach with first jejunal vein‐oriented mesenteric excision in pancreatoduodenectomy
Author(s) -
Ohtsuka Takao,
Nakamura Masafumi,
Tanaka Masao
Publication year - 2015
Publication title -
surgical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.109
H-Index - 10
eISSN - 1744-1633
pISSN - 1744-1625
DOI - 10.1111/1744-1633.12101
Subject(s) - medicine , superior mesenteric artery , sma* , superior mesenteric vein , pancreaticoduodenectomy , radiology , dissection (medical) , vein , surgery , portal vein , resection , mathematics , combinatorics
The superior mesenteric artery ( SMA ) first approach prior to the isolation of the portal vein ( PV )/superior mesenteric vein ( SMV ) from the pancreatoduodenal region during pancreatoduodenectomy was introduced to reduce blood loss due to congestion caused by the PV / SMV first approach. There are several SMA first approaches: the mesenteric approach for pancreatic head cancer and the anterior approach for other periampullary diseases are usually employed at our institution. In these approaches, identification of the first jejunal vein is a critical step to determine the optimal area for lymph node dissection along the SMA (mesoduodenum), and to identify the starting point of the SMA first approach to insulate the flow of the inferior pancreatoduodenal artery. We herein describe our SMA first approach with first jejunal vein‐oriented mesenteric excision during pancreatoduodenectomy.