Surgical techniques for pancreas transplantation.
OBJECTIVE
Pancreas transplantation reproducibly induces insulin independence in beta-cell penic diabetic patients. The difference between full insulin independence, partial graft function, and graft loss, mostly results from technical failure, graft rejection, and patient death with function graft. The purpose of this review is to examine recent surgical advances and discuss their contribution to improved graft function.


RESULTS
Few actual surgical innovations were described in the period reviewed. Duodenoduodenostomy is an interesting option for drainage of digestive secretions, when the pancreas is placed behind the right colon and is oriented cephalad. The main advantage of this technique is easy endoscopic assessment of donor duodenum but, when allograft pancreatectomy is necessary, repair of native duodenum may be troublesome. Selective revascularization of the gastroduodenal artery, at the back-table, possibly improves blood supply to the head of the pancreas graft and duodenal segment. There is no proof that this additional maneuver is always beneficial, although it can be graft saving in case of poor segmental graft perfusion.


CONCLUSIONS
Transplant surgeons should be familiar with all techniques for pancreas transplantation. Long-term graft function is possible only after technically successful pancreas transplantation. There is clearly a need for more objective assessment and standardization of surgical techniques for pancreas transplantation.
Boggi
Ugo
U
Division of General and Transplant Surgery in Uremic and Diabetic Patientss, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. u.boggi@med.unipi.it
Amorese
Gabriella
G
Marchetti
Piero
P
D003920:Diabetes Mellitus / Q000601:surgery*; D004322:Drainage; D004385:Duodenostomy; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D007166:Immunosuppressive Agents