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Vascular resection and reconstruction at pancreatico-duodenectomy:technical issues

Hepatobiliary & Pancreatic Diseases International 2012年第3期11卷 234-242页

作者： Edward CS Lai Pedder Clinic 4/F 9 Queen's Road Central

BACKGROUND:With the improvement of perioperative management over the years,pancreatico-duodenectomy has become a safe operation despite its technical *** presence of concomitant visceral artery occlusion unrelated to the underlying malignancy and concomitant major venous infiltration by tumor poses additional hazards to resection which could compromise the postoperative *** SOURCES:A MEDLINE database search was performed to identify relevant articles using the key ords 'median arcuate ligament syndrome','superior mesenteric artery','replaced right hepatic artery',and 'portal vein resection'.Additional papers and book chapters were identified by a manual search of the references from the key ***:Computed tomography with 3-dimensional reconstruction of the vascular anatomy provides most key information on the potential vascular problems encountered during surgery.A trial clamping of the gastroduodenal artery provides a simple intraoperative assessment for the presence of any significant visceral arterial *** on the timing of diagnosis,division of the median arcuate ligament,bypass or endovascular stenting should be *** and superior mesenteric vein resection had been used with increasing frequency and *** steps and methods taken to reconstruct the venous continuity vary with individual surgeons,and the anatomical variations *** segmental loss of the portal vein,opinions differs with regard to the preservation of the splenic vein,and when divided,the necessity of restoring its continuity;source of the autologous vein graft when needed and whether the use of synthetic graft is a safe ***:During a pancreatico-duodenectomy,images of computed tomography must be carefully studied to appreciate the changes and variation of vascular *** preoperative preparation,acute awareness of the probable arterial and venous anatomical variation and the availability of expert

关键词： pancreatico-duodenectomy vein resection celiac axis compression

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Chylous ascites after pancreatico-duodenectomy

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Hepatobiliary & Pancreatic Diseases International 2007年第4期6卷 416-419页

作者： Mansoor Ahmed Madanur Narendra Battula Muhammad Omar Azam Nigel Heaton Mohamed Rela Institute of Liver Studies Kings College Hospital Denmark HillLondon SE5 9RSUK

BACKGROUND:Chylous ascites(CA) following pancreatico-duodenectomy(PD) is a rare complication secondary to disruption of the lymphatics during extended retroperitoneal lymph node dissection. The majority of cases do not develop CA,possibly due to patency of the proximal thoracic duct and good collaterals. CA may be due to a consequence of occult obstruction of the proximal thoracic duct by malignant infiltration or tumor embolus. This study was to report the incidence of CA and its outcomes of management. METHODS:A retrospective search of our liver database was performed using the 'pancreatico-duodenectomy','chylous ascites' from January 2000 to December 2005. The medical records of CA patients and their management and outcome were reviewed. RESULTS:In 138 patients who had undergone PD in our centre for pancreatic malignancy,3 were identified with CA and managed by abdominal paracentesis. CA resolved in 2 patients with low fat medium chain triglyceride diet alone and 1 patient had total parenteral nutrition(TPN) for persistent CA. Resolution of CA occurred in these 3 patients at a median follow-up of 4 weeks(range 4-12 weeks). Histologically,resected specimen confirmed pancreatic adenocarcinoma in all the patients. Two patients developed loco-regional recurrences at a median follow up of 8 months(range 6-10 months). And the other was currently disease free at a 10-month follow up. CONCLUSIONS:CA as an uncommon postoperative complication requires frequent paracentesis,prolonged hospital stay,and delayed adjuvant chemotherapy. CA istreated with low fat medium chain triglyceride diet or occasionally TPN is required.

关键词： pancreatico-duodenectomy chylous ascites delayed adjuvant chemotherapy

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Intraoperative pancreas stump perfusion assessment during pancreaticoduodenectomy:A systematic scoping review

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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1799-1807页

作者： Francis P Robertson Harry V M Spiers Wei Boon Lim Benjamin Loveday Keith Roberts Sanjay Pandanaboyana Department of HPB and Transplant Surgery Freeman HospitalNewcastle Upon Tyne NE77DNUnited Kingdom Department of HPB Surgery Addenbrookes HospitalCambridge CB20QQUnited Kingdom Department of General Surgery Royal Melbourne HospitalMelbourne VIC 3050Australia Department of HPB Surgery University Hospitals Birmingham NHS Foundation TrustBirmingham BG152GWUnited Kingdom

BACKGROUND Post-operative pancreatic fistula(POPF)is the primary cause of morbidity following *** of POPF have remained high despite well known risk *** theory that hypoperfusion of the pancreatic stump leads to anastomotic failure has recently gained *** To define the published literature with regards to intraoperative pancreas perfusion assessment and its correlation with *** A systematic search of available literature was performed in November *** extracted included study characteristics,method of assessment of pancreas stump perfusion,POPF and other post-pancreatic surgery specific *** Five eligible studies comprised two prospective non-randomised studies and three case reports,total 156 *** studies used indocyanine green fluorescence angiography to assess the pancreatic stump,with the remaining study assessing pancreas perfusion by visual inspection of arterial bleeding of the pancreatic *** was significant heterogeneity in the definition of *** had a combined POPF rate of 12%;intraoperative perfusion assessment revealed hypoperfusion was present in 39%of patients who developed *** rate of POPF was 11%in patients with no evidence of hypoperfusion and 13%in those with evidence of hypoperfusion,suggesting that not all hypoperfusion gives rise to POPF and further analysis is required to analyse if there is a clinically relevant cut *** variance in practice was seen in the pancreatic stump management once hypoperfusion was *** The current published evidence around pancreas perfusion during pancreaticoduodenectomy is of poor *** does not support a causative link between hypoperfusion and *** well-designed prospective studies are required to investigate this.

关键词： pancreatico-duodenectomy Post-operative pancreatic fistula Perfusion Indocyanine green Post pancreatectomy pancreatitis

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