演題

IS-8-3

Technical refinement of pancreatoduodenectomy

[演者] 杉山 政則:1
[著者] 鈴木 裕:1, 中里 徹矢:1, 横山 政明:1, 阿部 展次:1, 正木 忠彦:1, 森 俊幸:1
1:杏林大学外科

Background: Pancreatoduodenectomy is one of the most complicated and technically demanding surgical procedures. It carries a high risk for postoperative morbidity. We have devised surgical techniques to surmount such problems.Intestinal derotation procedure: The entire right colon, duodenum and small bowel mesentery are mobilized from the retroperitoneum, and intestinal rotation is reduced. The mesopancreas stretches from the right side of the SMA and makes a horizontal plane. This procedure facilitates excision of the mesopancreas and division of the inferior pancreatoduodenal artery, particularly early division before ligation of the inferior pancreatoduodenal veins. Surgical outcomes of pancreatoduodenectomy were compared between derotation (n=82) and conventional (n=115) methods. Derotation procedure significantly decreased blood loss (588 ml vs. 908 ml) and shortened operation time (477 min vs. 516 min), and tended to allow R0 resection (88% vs. 78%).Pancreatic duct holder: A holder with a cone-shaped tip was devised for duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy. As the tip is inserted into the pancreatic duct, the duct can be expanded adequately. The holder allows easy and precise sutures. Incidences of pancreatic fistula were compared between duct-to-mucosa anastomosis with (n=163) or without (n=78) pancreatic duct holder. In cases of dilated pancreatic duct, the incidences were not different between two groups (5% vs. 6%). In cases of non-dilated pancreatic duct, pancreatic fistula tended to be less frequent after anastomosis using the holder (8% vs. 14%).Conclusion: Technical refinement of pancreatoduodenectomy may facilitate procedures and prevent postoperative complications.
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