title: Technical tailoring of pancreaticoduodenectomy in patients with hepatic artery anatomic variants.
abstract: BACKGROUND
  Pancreaticoduodenectomy is the treatment of choice for periampullary and pancreatic head tumors. In case of hepatic artery abnormalities, early pancreatic transection during pancreaticoduodenectomy may prove inappropriate. Early retroportal lamina dissection improves exposure of the superior mesenteric vessels and anatomic variants of the hepatic artery, where safeguarding is mandatory.
  
  
  METHODS
  We describe our early retroportal lamina approach in patients with anatomic variants of the hepatic artery before pancreatic transection.
  
  
  RESULTS
  This approach was used during 42 pancreaticoduodenectomies with a hepatic artery anatomic variant which was spared in 40 patients. Arterial reconstruction was performed in 2 patients. Five patients with a hepatic artery variant and adenocarcinoma involving the portomesenteric junction required venous resection and reconstruction.
  
  
  CONCLUSIONS
  Early retroportal lamina dissection during pancreaticoduodenectomy in patients with hepatic artery anatomic variants enables easier exposure, avoiding injuries that might compromise the liver arterial supply. When the portomesenteric vein is involved, this approach facilitates en bloc "no touch" venous resection and reconstruction.
authors.affiliation: First Surgical Unit, Gr. T. Popa University of Medicine and Pharmacy Iasi, St. Spiridon Hospital, Independentei Bld. 1, 700111 Iasi, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Lupascu
authors.forename: Dan
authors.initials: D
authors.lastname: Andronic
authors.forename: Corina
authors.initials: C
authors.lastname: Ursulescu
authors.forename: Ciprian
authors.initials: C
authors.lastname: Vasiluta
authors.forename: Nutu
authors.initials: N
authors.lastname: Vlad
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D054079:Vascular Malformations / Q000150:complications / Q000175:diagnosis*; D014656:Vascular Surgical Procedures / Q000379:methods*