Jurnalul de Chirurgie
 Jurnalul de chirurgie
Aparitie trimestriala in a doua luna a trimestrului
Published quarterly in the second month of the quarter
ISSN: 1584 - 9341 Vol.10 Nr.3 - Iulie-Septembrie 2014 | sâmbătă, 23 martie 2019
ISSN: 1584 - 9341 Vol.10 No.3 - July-September 2014
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EARLY RETROPANCREATIC DISSECTION DURING PANCREATICO-DUODENECTOMY - TECHNICAL NOTES
C. Lupascu (1), D. Andronic (1), R. Moldovanu (1), Corina Ursulescu (2),
C. Vasiluta (1), E. Tarcoveanu (1)
1. „I Tănăsescu – Vl. Buţureanu” First Surgical Clinic
2. St. Spiridon Hospital Radiological Clinic
„Gr. T. Popa” University of Medicine and Pharmacy Iaşi
Jurnalul de chirurgie 2011; 7 (1): 114-122
Full text:
Format PDF (Engleză/English)

Abstract:

Background: Pancreaticoduodenectomy (PD) is the procedure of choice for malignant tumors of the pancreatic head and periampullary region. During PD, early pancreatic neck division may be inadequate, especially in cases of hepatic artery (HA) anatomic variants, when invasion of the superior mesenteric artery (SMA) is suspected, or in cases of intraductal papillary mucinous neoplasms (IPMN). Methods: We perform an early approach of the retroportal lamina (RPL) from behind the pancreatic head, before pancreatic transection. This is accomplished after lymphadenectomy and adequate mobilisation of the specimen from the vessels, on either the neck or the body, according to the tumor extension. Results: We successfully used this approach during 28 PD. There were 21 patients to whom we detected anatomic variants of right hepatic artery (RHA), which was spared in 19 cases; arterial reconstruction was required in one case. We also used this technique in 5 patients with IPMN - 3 PD extented to the body and 2 total pancreatectomies,  and in other 2 patients with adenocarcinoma involving the porto-mesenteric jonction, requiring limited venous resection and reconstruction. Conclusions: Retropancreatic approach with early RPL dissection is an useful technical variant of pancreaticoduodenectomy which we recommend in selective indications.

KEY WORDS: PANCREATICODUODENECTOMY, POSTERIOR APPROACH, RIGHT HEPATIC ARTERY, SUPERIOR MESENTERIC ARTERY, INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM


List of abbreviations: CBD- common bile duct; Ct- celiac trunk; IPMN- intraductal papillary mucinous neoplasm; HA- hepatic artery; MDCT- multidetector computed tomography; PD- pancreaticoduodenectomy; PH- porta hepatis; PV-  portal vein; RPL- retropancreatic lamina; RHA- right heparic artery; RCHA- replaced common hepatic artery; SMA- superior mesenteric artery; SMV- superior mesenteric vein.

Correspondence to:
Associate Professor Cristian Lupascu, MD, PhD. „I Tănăsescu – Vl. Buţureanu” First Surgical Clinic, St. Spiridon Hospital, Independentei street, no 1, 700111; e-mail:



: Creative Commons License
Jurnalul de chirurgie [Journal of Surgery] by Editorial Board, Department of Surgery University of Medicine and Pharmacy Iasi, E. Tarcoveanu, R. Moldovanu is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Based on a work at www.jurnaluldechirurgie.ro.