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Girish S, Kapil N, Kannan N. Central Pancreatectomy: Significance of Vascularity on Anastomotic Integrity and a Note on Reconstructive Technique. Cureus 2021; 13:e18617. [PMID: 34765372 PMCID: PMC8573194 DOI: 10.7759/cureus.18617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/05/2022] Open
Abstract
Central pancreatectomy is a pancreatic parenchymal sparing surgery usually indicated for benign and borderline malignant tumors of the neck and proximal body of the pancreas. Due to the presence of extensive intra-pancreatic spread, pancreatic parenchyma sparing procedures such as central pancreatectomy are invariably deferred in pancreatic malignancy. The need for management of two pancreatic stumps with a usually soft texture and non-dilated ducts, given the indications, increases the risk of pancreatic fistula and therefore morbidity. Proximal stump management is usually a closure either by suture or stapler with reinforcements; the technique preferred depends on the experience of the surgeon and is mostly extrapolated from distal pancreatectomy. Distal stump management is the Achilles’ heel owing to the texture of the pancreas and pancreatic duct size. Need for additional mobilization may have a bearing on the perfusion of the pancreatic stump and hence may lead to clinically relevant leaks. The use of octreotide accentuating the said vascular insufficiency may not be an overstatement. Here we present a case of solid pseudopapillary tumor (SPT) of the neck and proximal body of the pancreas in which a central pancreatectomy with falciform patch closure of the proximal stump and binding pancreaticogastrostomy (PG) was contemplated and further we discuss the types of reconstruction with special reference to the vascular pattern of distal pancreas.
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Affiliation(s)
- Suraj Girish
- General Surgery, Meenakshi Medical College and Research Institute, Kanchipuram, IND
| | - Nagaraj Kapil
- Surgical Gastroenterology, Meenakshi Medical College and Research Institute, Kanchipuram, IND
| | - Naveen Kannan
- General Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, IND
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Nakao A, Yamada S, Fujii T, Tanaka H, Oshima K, Oshima Y, Iede K, Kobayashi H, Kimura Y, Kodera Y. Gastric venous congestion and bleeding in association with total pancreatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 25:150-154. [PMID: 29143477 PMCID: PMC5814835 DOI: 10.1002/jhbp.523] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastric venous congestion and bleeding in association with total pancreatectomy (TP) were evaluated. METHODS Thirty-eight patients of TP were retrospectively analyzed. TP was classified as TP with distal gastrectomy (TPDG), pylorus-preserving TP (PPTP), subtotal stomach-preserving TP (SSPTP), and TP with segmental duodenectomy (TPSD). RESULTS Portal vein or superior mesenteric vein resection and reconstruction was performed in 24 patients (62.2%). Gastric bleeding occurred immediately after tumor resection in one of eight patients who underwent SSPTP, and urgent anastomosis between the right gastroepiploic and left ovarian vein stopped the bleeding. Another case of gastric bleeding was observed a few hours after TP in one of nine patients who underwent PPTP, and hemostasis was achieved after conservative therapy. Gastric bleeding was not observed in 16 patients who underwent TPDG and five who underwent TPSD. Some patients underwent preservation of gastric drainage veins (left gastric vein, right gastric vein, or right gastroepiploic vein). Neither patient with bleeding underwent preservation of a gastric drainage vein. CONCLUSIONS To preserve the subtotal or whole stomach when performing TP, one of the gastric drainage veins should undergo preservation or reconstruction, and anastomosis between the right gastroepiploic vein and left ovarian vein may be beneficial.
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Affiliation(s)
- Akimasa Nakao
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, Aichi 453-0801, Japan
| | - Suguru Yamada
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tsutomu Fujii
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Haruyoshi Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Oshima
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, Aichi 453-0801, Japan
| | - Yukiko Oshima
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, Aichi 453-0801, Japan
| | - Kiyotsugu Iede
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hironobu Kobayashi
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, Aichi 453-0801, Japan
| | - Yasunori Kimura
- Department of Surgery, Nagoya Central Hospital, 3-7-7 Taiko, Nakamura-ku, Nagoya, Aichi 453-0801, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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