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Kawaguchi N, Kizawa S, Daimon M, Minami H, Ueda Y, Tomioka A, Komeda K, Asakuma M, Tomiyama H, Lee SW. Surgical management of right hepatectomy after coronary artery bypass grafting using the right gastroepiploic artery: a case report and literature review. World J Surg Oncol 2024; 22:119. [PMID: 38702732 PMCID: PMC11067127 DOI: 10.1186/s12957-024-03401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) is a well-established, safe procedure. However, problems with RGEA grafts in subsequent abdominal surgeries can lead to fatal complications. This report presents the first case of right hepatectomy for hepatocellular carcinoma after CABG using the RGEA. CASE PRESENTATION We describe a case in which a right hepatectomy for an 81-year-old male patient with hepatocellular carcinoma was safely performed after CABG using a RGEA graft. Preoperatively, three-dimensional computed tomography (3D- CT) images were constructed to confirm the run of the RGEA graft. The operation was conducted with the standby of a cardiovascular surgeon if there was a problem with the RGEA graft. The RGEA graft had formed adhesions with the hepatic falciform ligament, necessitating meticulous dissection. After the right hepatectomy, the left hepatic lobe descended into the vacated space, exerting traction on the RGEA. However, this traction was mitigated by suturing the hepatic falciform ligament to the abdominal wall, ensuring stability of the RGEA. There were no intraoperative or postoperative complications. CONCLUSION It is crucial to confirm the functionality and anatomy of the RGEA graft preoperatively, handle it gently intraoperatively, and collaborate with cardiovascular surgeons.
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Affiliation(s)
- Nao Kawaguchi
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University , 2-7 Daigaku-machi, Takatsuki, 569-8686, Osaka, Japan.
| | - Shun Kizawa
- Department of Cardiology, Takatsuki Red Cross Hospital, 1-1-1 Abuno, Takatsuki, 569- 1096, Osaka, Japan
| | - Masahiro Daimon
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Osaka, Japan
| | - Hiroki Minami
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University , 2-7 Daigaku-machi, Takatsuki, 569-8686, Osaka, Japan
| | - Yasuhiko Ueda
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University , 2-7 Daigaku-machi, Takatsuki, 569-8686, Osaka, Japan
| | - Atsushi Tomioka
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University , 2-7 Daigaku-machi, Takatsuki, 569-8686, Osaka, Japan
| | - Koji Komeda
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University , 2-7 Daigaku-machi, Takatsuki, 569-8686, Osaka, Japan
| | - Mitsuhiro Asakuma
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University , 2-7 Daigaku-machi, Takatsuki, 569-8686, Osaka, Japan
| | - Hideki Tomiyama
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University , 2-7 Daigaku-machi, Takatsuki, 569-8686, Osaka, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University , 2-7 Daigaku-machi, Takatsuki, 569-8686, Osaka, Japan
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Matsumura M, Kobayashi M, Okubo S, Haruta S, Koyama R, Uruga H, Shindoh J, Imamura T, Takazawa Y, Hashimoto M. Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case report. Surg Case Rep 2023; 9:117. [PMID: 37356046 DOI: 10.1186/s40792-023-01700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Pancreatic head resection following proximal gastrectomy jeopardizes the blood flow of the remnant stomach owing to right gastroepiploic conduit sacrifice, thereby necessitating total gastrectomy. However, owing to its high invasiveness, concomitant remnant total gastrectomy with pancreatectomy should be avoided as much as possible. Herein, we describe our experience of total pancreatectomy with right gastroepiploic conduit preservation in a patient with a history of proximal gastrectomy and reconstruction by jejunum interposition. CASE PRESENTATION A 78-year-old woman with a history of gastric cancer was followed up at our institute for multiple intraductal papillary mucinous neoplasm, and main pancreatic duct stricture in the pancreatic head was newly detected. The cystic lesion was extended to the pancreatic body. Proximal gastrectomy and reconstruction by jejunal interposition were previously performed, and the mesenteric stalk of the interposed jejunum was approached through the retrocolic route. We planned total pancreatectomy with right gastroepiploic conduit preservation. Following adhesiolysis, the interposed jejunum and its mesentery lying in front of the pancreas were isolated. The arterial arcade from the common hepatic artery to the right gastroepiploic artery was detached from the pancreas. Furthermore, the right gastroepiploic vein was isolated from the pancreas. The pancreatic body and tail were pulled up in front of the remnant stomach, and the splenic artery and vein were resected. The pancreatic body and tail were pulled out to the right side, and the pancreatic head was divided from the pancreatic nerve plexus to the portal vein. The jejunal limb for entero-biliary anastomosis was passed through the hole behind the superior mesenteric artery and vein, and gastrointestinal anastomosis using the antecolic route and Braun anastomosis were performed. CONCLUSIONS To avoid remnant total gastrectomy, right gastroepiploic conduit preservation is an optional procedure for pancreatic head resection in patients who have undergone proximal gastrectomy with reconstruction by jejunal interposition.
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Affiliation(s)
- Masaru Matsumura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan.
| | - Masahiro Kobayashi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Satoshi Okubo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Shusuke Haruta
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Rikako Koyama
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Hironori Uruga
- Department of Diagnostic Pathology, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Junichi Shindoh
- Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Tsunao Imamura
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yutaka Takazawa
- Department of Diagnostic Pathology, Toranomon Hospital, Tokyo, Japan
| | - Masaji Hashimoto
- Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
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Toda T, Kanemoto H, Tokuda S, Takagi A, Oba N. Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting: A case report and review of literature. Medicine (Baltimore) 2021; 100:e27788. [PMID: 35049175 PMCID: PMC9191372 DOI: 10.1097/md.0000000000027788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Pancreaticoduodenectomy (PD) is a technically demanding procedure with high rates of morbidity and mortality. Therefore, preoperative evaluation of anatomy is indispensable. Multi-detector row computed tomography (CT) enables us to precisely understand arterial anatomy. It is a well-known fact that anatomical variants are often present in the hepatic artery (HA) but rarely in the gastroduodenal artery (GDA). We present the case of a patient with ampullary cancer with a rare anatomical anomaly, "replaced GDA (rGDA) " arising from the superior mesenteric artery, along with a history of coronary artery bypass grafting (CABG) using right gastroepiploic artery (RGEA). PATIENT CONCERNS A 69-year-old male patient was referred to our department for further investigation of elevated hepatobiliary enzymes. He presented with no symptoms besides intermittent fever of 38°C. He had an operative history of CABG using the RGEA. DIAGNOSIS Abdominal CT and esophagogastroduodenoscopy showed an ampullary tumor and biopsy specimen from the lesion revealed adenocarcinoma. CT angiography revealed the rGDA instead of a normal common HA. INTERVENTION We performed a safe PD, preserving the rGDA and the RGEA to maintain hepatic and cardiac perfusion. OUTCOMES Owing to the presence of a refractory pancreatic fistula, the length-of-hospital stay was extended, and he was discharged on postoperative day 72 without vascular complications. At present, the patient is in good physical condition and does not present with cardiovascular complications as well as tumor recurrence at 6 months after surgery. LESSONS This is possibly the first case of a patient who underwent PD and has a proper HA following a GDA arising from a superior mesenteric artery (rGDA) and has a previous operative history of CABG using the gastroepiploic artery. The coexistence of the history of cardiovascular surgery made PD for this patient considerably more challenging.In the case of a rare anatomical anomaly, a coronary artery bypass via the RGEA should not be considered as an obstacle when R0 resection is achievable.
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Affiliation(s)
- Takeo Toda
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Hideyuki Kanemoto
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Satoshi Tokuda
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Akihiko Takagi
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
| | - Noriyuki Oba
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
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Homsy K, Paquay JL, Farghadani H. Cephalic pancreaticoduodenectomy with preservation of a right coronary artery bypass graft using the right gastro-epiploic artery: a case report. Acta Chir Belg 2019; 119:186-188. [PMID: 29463197 DOI: 10.1080/00015458.2018.1430219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pancreatic cancer is a rare disease with a high mortality rate, for which complete surgical resection, when possible, is the preferred therapeutic. Pancreaticoduodenectomy represents the surgical technique of choice. Abdominal surgeons can be faced with the challenge of patients with a history of coronary artery bypass graft in which the right gastro-epiploic artery is used. CASE REPORT We report the case of a patient with an adenocarcinoma of the pancreatic head, stage IIA, having previously undergone a triple coronary artery bypass, one of which being a right gastro-epiploic graft. Our challenge was underlined by the necessity of a complete oncological resection through a cephalic pancreaticoduodenectomy while preserving the necessary cardiac perfusion via the right gastro-epiploic artery. CONCLUSION We have been able to preserve a right gastro-epiploic artery as a coronary bypass during a cephalic pancreaticoduodenectomy for a cephalic pancreatic adenocarcinoma. We have successfully been able to preserve and re-implant the right gastro-epiploic artery to the origin of the gastroduodenal artery while insuring R0 resection of the tumor. A coronary artery bypass using the right gastro-epiploic artery should therefore not be considered as an obstacle to a Whipple's procedure if total oncological resection is obtainable.
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Affiliation(s)
- K. Homsy
- Department of General Surgery, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - J.-L. Paquay
- Department of Cardiology, Clinique Saint Joseph, Arlon, Belgium
| | - H. Farghadani
- Department of General Surgery, Clinique Saint Joseph, Arlon, Belgium
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Sakai K, Mizuno T, Watanabe T, Nagaoka E, Oi K, Yashima M, Hachimaru T, Kuroki H, Fujiwara T, Takeshita M, Tanabe M, Arai H. Management of Right Gastroepiploic Arterial Coronary Grafts in Subsequent Abdominal Surgeries. Ann Thorac Surg 2018; 106:52-57. [DOI: 10.1016/j.athoracsur.2018.01.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/11/2018] [Accepted: 01/26/2018] [Indexed: 12/26/2022]
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Fujikawa T, Noda T, Arai Y, Tanaka A. Resection of pancreatic head neoplasm in a patient with previous coronary bypass grafting using right gastroepiploic artery. BMJ Case Rep 2014; 2014:bcr-2014-204132. [PMID: 24903970 DOI: 10.1136/bcr-2014-204132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Tomohiro Noda
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshio Arai
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Akira Tanaka
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
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