title: Mesopancreas first dissection during pancreaticoduodenal resection: selective approach or paradigm?
abstract: OBJECTIVE
  Pancreaticoduodenal resection is the procedure of choice for tumors of the pancreatic head and periampullary region. During pancreaticoduodenectomy resection, early neck division may be impossible or inadequate in case of hepatic artery anatomic variants, suspected involvement of the superior mesenteric vessels or intraductal papillary mucinous tumors. This paper aims to reveal the effectiveness of a modified posterior approach pancreaticoduodenectomy in selected indications and to assess the preliminary results.
  
  
  METHODS
  We describe our early approach to the retropancreatic vasculature during pancreaticoduodenal resection by mesopancreas first dissection before any pancreatic or digestive transection.
  
  
  RESULTS
  We used this approach in 45 patients. Thirty had hepatic artery anatomic variant. Hepatic artery reconstruction was required in 2 cases. In nine patients with intraductal papillary mucinous tumors the pancreaticoduodenal resection was extended to the body in 6 and totalized in 3 patients. In six patients with adenocarcinoma involving the portomesenteric axis, venous resection and reconstruction was necessary.
  
  
  CONCLUSIONS
  Mesopancreas first dissection is useful tool in selected cases of pancreaticoduodenal resection to improve safety and radicality of the procedure.
authors.forename: Cristian
authors.initials: C
authors.lastname: Lupaşcu
authors.forename: Dan
authors.initials: D
authors.lastname: Andronic
authors.forename: Valentin Titus
authors.initials: VT
authors.lastname: Grigorean
authors.forename: Corina
authors.initials: C
authors.lastname: Ursulescu
mesh_terms: D000328:Adult; D000368:Aged; D004210:Dissection; D005260:Female; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000033:anatomy & histology; D008875:Middle Aged; D010179:Pancreas / Q000033:anatomy & histology* / Q000098:blood supply*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications