Vascular Anatomy of Mesopancreas in Pancreatoduodenectomy Using an Intestinal Derotation Procedure
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ORIGINAL SCIENTIFIC REPORT
Vascular Anatomy of Mesopancreas in Pancreatoduodenectomy Using an Intestinal Derotation Procedure Masanori Sugiyama1,2 • Yutaka Suzuki1 • Tetsuya Nakazato1 • Masaaki Yokoyama1 Masaharu Kogure1 • Ryota Matsuki1 • Nobutsugu Abe1
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Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Mesopancreas excision in pancreatoduodenectomy is technically complicated because of the anatomical complexity of the mesopancreas with the inferior peripancreatic blood vessels which is caused by intestinal rotation in fetal life. We have developed a novel artery-first approach (the intestinal derotation procedure) for facilitating mesopancreas excision. The aim of this study was to clarify the vascular anatomy of the mesopancreas after derotation. Methods The right-sided colon and small intestine are mobilized from the retroperitoneum, and the intestinal loop is then derotated. In 136 cases of pancreatoduodenectomy employing the derotation procedure, we analyzed the vascular anatomy of the mesopancreas. Results After derotation, the anatomy was simplified. The mesopancreas extended from the right aspect of the superior mesenteric artery (SMA), forming a horizontal plane. The first jejunal trunk (FJT) was situated in parallel with the second jejunal artery and was anterior (91%) or posterior (9%) to the SMA. The inferior pancreaticoduodenal vein (IPDV) entered the right side of the FJT (83%) or the superior mesenteric vein (17%). Besides the IPDV, 1–4 tributaries entered the right wall of the FJT, in 89% of cases. The inferior pancreaticoduodenal artery was observed to originate from the right wall of the SMA, sharing a common stem with the first jejunal artery (70%) or branching directly from the SMA (29%). Conclusions Intestinal derotation simplifies the mesopancreas anatomy and reveals the anatomical details of the inferior peripancreatic blood vessels in pancreatoduodenectomy.
Abbreviations FJT First jejunal trunk ICA Ileocolic artery IPDA Inferior pancreaticoduodenal artery IPDV Inferior pancreaticoduodenal vein JIA First jejunal artery & Masanori Sugiyama [email protected] 1
Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
2
Tokyo Rosai Hospital, 4-13-21 Omori-Minami, Ota-ku, Tokyo 143-0013, Japan
J2A JIV J2V MCA PD PV RCA SMA SMV
Second jejunal artery First jejunal vein Second jejunal vein Middle colic artery Pancreatoduodenectomy Portal vein Right colic artery Superior mesenteric artery Superior mesenteric vein
123
World J Surg
Introduction Mesopancreas excision is an important component of pancreatoduodenectomy (PD). The mesopancreas indicates the mesentery which extends from the superior mesenteric artery (SMA) to the pancreas (actually, the pancreatic head, duodenum and uppermost jejunum) [1]. This mesentery contains a nerve plexus, lymphatic nodes and vessels, and blood vessels, including the inferior pancreaticoduodenal artery (IPDA) and vein (IPDV). Complete mesopancreas excision is required for curative res
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