Anterior tributaries of the portal vein at the superior margin of the pancreas: is "tunneling" procedure safe during pancreatic surgery?
BACKGROUND
It is widely believed that using the "tunneling" procedure during pancreatoduodenectomy is a safe maneuver because the anterior tributaries of the portal vein (PV) are absent or very rare.


METHODS
The head of the pancreas with the duodenum and the common bile duct (CBD) was obtained from 22 autopsy cases. Three colors of silicon-polymerase dyes were injected into the pancreatic artery, PV, and bile duct. The tributaries of the PV at the superior margin of the pancreas were studied.


RESULTS
There was no anterior branch of the intrapancreatic PV. The anterior superior pancreaticoduodenal vein (ASPDV) gave a definite branch to the anterior aspect of the PV at the superior margin of the pancreas in 4 of 22 cases. When the posterior superior pancreaticoduodenal vein (PSPDV) was located in front of the CBD (5 of 22 cases), the ASPDV and PSPDV had a thick common trunk at the right side of the PV. In these 5 cases, no individual branch from the ASPDV was found at the anterior aspect of the PV.


CONCLUSIONS
PV sometimes has a definite anterior tributary at the superior margin of the pancreas; this must be kept in mind to perform the tunneling procedure during pancreatic surgery.
Sakamoto
Y
Y
Department of Surgery, Asahi General Hospital, Chiba, Japan. sakamoto-2su@h.u-tokyo.ac.jp
Nagai
M
M
Tanaka
N
N
Tsukamoto
T
T
Nokubi
M
M
Suzuki
Y
Y
Nobori
M
M
D000328:Adult; D000368:Aged; D004396:Coloring Agents / Q000737:chemistry; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000033:anatomy & histology*; D012825:Silicon / Q000737:chemistry
D004396:Coloring Agents; D012825:Silicon