title: Use of the recanalised umbilical vein for islet autotransplantation following total pancreatectomy.
abstract: BACKGROUND
  Islet autotransplantation requires access to the portal vein or tributaries. We originally infused islets into the liver via the middle or right colic veins, but since 2005 we have used the recanalised umbilical vein. Here, we describe the technique, the advantages and the early results achieved.
  
  
  METHODS
  After removal of the pancreas and restoration of the biliary and enteric continuity, the ligamentum teres is transected. The obliterated umbilical vein is identified and recanalised with Bakes dilators giving access to the left portal vein. A Vygon® Nutricath 'S' 11-Fr catheter is inserted and used for the islet infusion. If the ligamentum teres is to be exteriorised for postoperative measurements or subsequent access, it is pulled through a 10-mm laparoscopic port in the epigastrium, sutured to the skin and covered with a dressing.
  
  
  RESULTS
  We have used this approach in 17 patients and exteriorised the falciform ligament in 4. There have been no intra- or postoperative complications.
  
  
  CONCLUSIONS
  The recanalised umbilical approach is safe and allows for venous sampling and postoperative measurements of the portal pressure. Under local anaesthetic, the umbilical vein can be approached above the umbilicus and exteriorised if repeated transplants are required for allograft patients. and IAP.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK.
authors.forename: Cristina
authors.initials: C
authors.lastname: Pollard
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Gravante
authors.forename: M'Balu
authors.initials: M
authors.lastname: Webb
authors.forename: Wen Yuan
authors.initials: WY
authors.lastname: Chung
authors.forename: Severine
authors.initials: S
authors.lastname: Illouz
authors.forename: Seok Ling
authors.initials: SL
authors.lastname: Ong
authors.forename: Patrick
authors.initials: P
authors.lastname: Musto
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison
mesh_terms: D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008875:Middle Aged; D010180:Pancreatectomy; D011169:Portal Vein / Q000601:surgery; D014182:Transplantation, Autologous / Q000379:methods*; D014471:Umbilical Veins / Q000601:surgery*