Pancreatoduodenectomy in which dissection of the efferent arteries of the head of the pancreas is performed first.
OBJECTIVE
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.
Horiguchi
Akihiko
A
Second Department of Gastroenterological Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan.
Ishihara
Shin
S
Ito
Masahiro
M
Nagata
Hideo
H
Shimizu
Tomohiro
T
Furusawa
Koichi
K
Kato
Ryoichi
R
Katada
Kazuhiro
K
Miyakawa
Shuichi
S
D000368:Aged; D001158:Arteries / Q000601:surgery*; D001650:Bile Duct Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D010179:Pancreas / Q000098:blood supply*; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome