Yosuke Inoue1, Akio Saiura2, Masayuki Tanaka1, Masaru Matsumura1, Yoshinori Takeda1, Yoshihiro Mise1, Takeaki Ishizawa1, Yu Takahashi1. 1. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. 2. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. saiura-tky@umin.ac.jp.
Abstract
INTRODUCTION: Use of central vascular ligation during dissection around the superior mesenteric artery (SMA) in pancreaticoduodenectomy (PD) for periampullary malignancies has rarely been documented. METHODS: We developed the SMA hanging technique (SHT) to facilitate central vascular ligation during PD. Briefly, SMA dissection was initiated using the supracolic anterior approach, followed by left-sided dissection. The SMA was taped under finger guidance immediately after right-sided dissection. The ligament of Treitz was detached from the SMA during left-sided dissection, facilitating adequate lymph node dissection while preserving the nerve plexus around the SMA. Forty-seven consecutive patients who underwent PD for periampullary malignancies were divided into two groups: 23 underwent SHT and 24 underwent conventional dissection. Patients' clinical results were assessed to evaluate the feasibility and validity of SHT. RESULTS: Blood loss volume, operation duration, and the incidence of bleeding during SMA dissection were significantly lower in the SHT group than in the conventional group. The short-term and oncological results were similarly acceptable in both groups. CONCLUSIONS: SHT is a feasible and safe technique with acceptable short-term outcomes. We propose the use of this procedure to standardize en bloc dissection around the SMA.
INTRODUCTION: Use of central vascular ligation during dissection around the superior mesenteric artery (SMA) in pancreaticoduodenectomy (PD) for periampullary malignancies has rarely been documented. METHODS: We developed the SMA hanging technique (SHT) to facilitate central vascular ligation during PD. Briefly, SMA dissection was initiated using the supracolic anterior approach, followed by left-sided dissection. The SMA was taped under finger guidance immediately after right-sided dissection. The ligament of Treitz was detached from the SMA during left-sided dissection, facilitating adequate lymph node dissection while preserving the nerve plexus around the SMA. Forty-seven consecutive patients who underwent PD for periampullary malignancies were divided into two groups: 23 underwent SHT and 24 underwent conventional dissection. Patients' clinical results were assessed to evaluate the feasibility and validity of SHT. RESULTS: Blood loss volume, operation duration, and the incidence of bleeding during SMA dissection were significantly lower in the SHT group than in the conventional group. The short-term and oncological results were similarly acceptable in both groups. CONCLUSIONS: SHT is a feasible and safe technique with acceptable short-term outcomes. We propose the use of this procedure to standardize en bloc dissection around the SMA.
Entities:
Keywords:
Dissection; Ligation; Mesopancreas; Pancreaticoduodenectomy; Superior mesenteric artery
Authors: Charles J Yeo; John L Cameron; Keith D Lillemoe; Taylor A Sohn; Kurtis A Campbell; Patricia K Sauter; JoAnn Coleman; Ross A Abrams; Ralph H Hruban Journal: Ann Surg Date: 2002-09 Impact factor: 12.969
Authors: Eduardo de Souza M Fernandes; Oliver Strobel; Camila Girão; Jose Maria A Moraes-Junior; Orlando Jorge M Torres Journal: Langenbecks Arch Surg Date: 2021-06-12 Impact factor: 3.445
Authors: M Franceschilli; D Vinci; S Di Carlo; B Sensi; L Siragusa; A Guida; P Rossi; V Bellato; R Caronna; S Sibio Journal: Discov Oncol Date: 2021-08-06