Preliminary experience with the hanging maneuver for pancreaticoduodenectomy.
BACKGROUND
Malignant periampullary tumours often invade retroperitoneal peripancreatic tissues and a positive resection margin following pancreaticoduodenectomy (PD) is associated with a poor survival. The margin most frequently invaded is the retroperitoneal margin (RM). Among the different steps of PD one of the most difficult and less codified is the resection of the RM with high risk of bleeding. We have developed a surgical technique - "hanging maneuver" - which allows at the same time a standardization of this step, a complete resection of the RM, and an optimal control of bleeding.


METHODS
We described the surgical technique, and we reported our preliminary experience. Surgical data, postoperative outcome and pathological results of patients submitted to PD for pancreatic carcinoma using "hanging maneuver" technique between January 2007 and December 2007 were reviewed.


RESULTS
The hanging maneuver was performed in 20 patients without any intraoperative complication and massive bleeding. No patient required blood transfusion. After had inked the surgical margins, retroperitoneal peripancreatic tissue was invaded in 12 out of 17 patients with malignant diseases (70.5%). In only one case (6%), the retroperitoneal margin was involved by the tumour (R1 resection).


CONCLUSIONS
The "hanging maneuver" is a useful and safe technical variant and should be considered in the armamentarium of the pancreatic surgeons in order to achieve negative retroperitoneal margins.
Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098 Strasbourg Cedex, France. patrick.pessaux@chru-strasbourg.fr
P
P
Pessaux
E
E
Rosso
F
F
Panaro
E
E
Marzano
E
E
Oussoultzoglou
P
P
Bachellier
D
D
Jaeck
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006801:Humans; D017538:Mesenteric Artery, Superior; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012187:Retroperitoneal Space / Q000098:blood supply / Q000473:pathology / Q000601:surgery*