Antegrade en bloc distal pancreatectomy with plexus hanging maneuver.
BACKGROUND
Although antegrade en bloc distal pancreatectomy is appropriate for invasive distal pancreatic malignancies, this technique is not easy to perform because the end-point of deep vertical resections cannot be controlled. This report describes the usefulness of the application of hanging maneuver in performing the radical surgery.


METHODS
A tape for guidance is passed in a space behind the bundles of the left celiac and mesenteric plexus, followed by sagittal resection of the distal pancreas exposing the root of the celiac artery and superior mesenteric artery. After dividing the pancreas down to the level of the roots of the celiac and superior arteries, the distal pancreas is dissected from the retroperitoneum in medial to lateral fashion.


RESULTS
This technique was applied in six patients with distal pancreas malignancies, without any positive cancer cells at the resected margin. The mean tumor size was 3.0±0.9 cm. The mean duration of surgery and intraoperative blood loss were 258±71 min and 226±240 ml, respectively.


CONCLUSIONS
Antegrade en bloc distal pancreatectomy with plexus hanging maneuver is an appropriate technique for treating distal pancreatic malignancies.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. tikesurg@yahoo.co.jp
Toru
T
Ikegami
Takashi
T
Maeda
Eiji
E
Oki
Hiroto
H
Kayashima
Kippei
K
Ohgaki
Yoshihisa
Y
Sakaguchi
Ken
K
Shirabe
Yoshihiko
Y
Maehara
D000368:Aged; D002915:Chylous Ascites / Q000209:etiology; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D008297:Male; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery