Common hepatic artery revascularization using splenic artery bypass after en bloc resection of the celiac axis

Surgery ◽  
2013 ◽  
Vol 154 (5) ◽  
pp. 1139-1141
Author(s):  
Rishi Dave ◽  
Sartaj S. Sanghera ◽  
Gregory S. Cherr ◽  
Neal W. Wilkinson
Keyword(s):  
Hepatic Artery ◽  
Splenic Artery ◽  
Artery Bypass ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Common Hepatic Artery ◽  
Celiac Axis ◽  
En Bloc

scholarly journals Extended Distal Pancreatectomy with En Bloc Resection of the Celiac Axis for Locally Advanced Pancreatic Cancer: A Case Report and Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Patrick H. Alizai ◽  
Andreas H. Mahnken ◽  
Christian D. Klink ◽  
Ulf P. Neumann ◽  
Karsten Junge
Keyword(s):  
Case Report ◽  
Distal Pancreatectomy ◽  
Locally Advanced ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Common Hepatic Artery ◽  
Celiac Axis ◽  
Review Of The Literature ◽  
En Bloc ◽  
The Common

Due to a lack of early symptoms, pancreatic cancers of the body and tail are discovered mostly at advanced stages. These locally advanced cancers often involve the celiac axis or the common hepatic artery and are therefore declared unresectable. The extended distal pancreatectomy with en bloc resection of the celiac artery may offer a chance of complete resection. We present the case of a 48-year-old female with pancreatic body cancer invading the celiac axis. The patient underwent laparoscopy to exclude hepatic and peritoneal metastasis. Subsequently, a selective embolization of the common hepatic artery was performed to enlarge arterial flow to the hepatobiliary system and the stomach via the pancreatoduodenal arcades from the superior mesenteric artery. Fifteen days after embolization, the extended distal pancreatectomy with splenectomy and en bloc resection of the celiac axis was carried out. The postoperative course was uneventful, and complete tumor resection was achieved. This case report and a review of the literature show the feasibility and safety of the extended distal pancreatectomy with en bloc resection of the celiac axis. A preoperative embolization of the celiac axis may avoid ischemia-related complications of the stomach or the liver.

scholarly journals Hepatic Artery Embolization prior to En Bloc Resection of an Encased Common Hepatic Artery in Adenocarcinoma of the Head of the Pancreas

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Gregory Sergeant ◽  
Erik Schadde ◽  
Geert Maleux ◽  
Raymond Aerts
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Balloon Dilation ◽  
En Bloc Resection ◽  
Common Hepatic Artery ◽  
Pathological Examination ◽  
Periampullary Cancer ◽  
En Bloc ◽  
Head Of The Pancreas ◽  
The Common

A 64-year-old female patient with adenocarcinoma of the head of the pancreas with encasement of the common hepatic artery and portal vein stenosis was reexplored after six cycles of gemcitabine (1000 mg/m2). Prior to surgery, the patient underwent balloon dilation and stenting of the portal vein in addition to successful coil embolisation of the common hepatic artery, proper hepatic artery, and proximal gastroduodenal artery. After embolisation, a pylorus-preserving pancreaticoduodenectomy was performed with resection of the common hepatic artery and portal vein confluens. Pathological examination showed a moderately differentiated pT3N0 (Stage IIa, TNM 7th edition) tumor with negative section margins. We show with this case that in selected cases of periampullary cancer with encasement of the common hepatic artery, it is technically feasible to perform pancreaticoduodenectomy with hepatic artery resection and negative surgical margins. Nevertheless, the oncological benefit of extended arterial resections remains controversial.

Giant Splenic Artery Pseudoaneurysm: A Case Report and Literature Review

2015 ◽  
Vol 100 (7-8) ◽  
pp. 1244-1248 ◽  
Author(s):  
Yusuf Yagmur ◽  
Sami Akbulut ◽  
Serdar Gumus ◽  
Firat Demircan
Keyword(s):  
Splenic Artery ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Clinical Findings ◽  
Abdominal Aneurysm ◽  
En Bloc ◽  
Abdominal Ultrasonography ◽  
Artery Pseudoaneurysm ◽  
Contrast Enhanced Ct ◽  
Asymptomatic Patients

Splenic artery aneurysms (SAAs) are the third most frequent intra-abdominal aneurysm, following abdominal aorta and iliac artery aneurysms. SAAs are classified according to their involvement of arterial wall layers: true aneurysms involve all 3 layers (intima, media, and adventitia), and pseudoaneurysms involve only one or two. Herein we present a new case of giant pseudo SAA. A 65-year-old female patient with a pancreatic mass and iron deficiency was referred to our clinic for further investigation. Abdominal ultrasonography, contrast-enhanced CT and magnetic resonance imaging showed a lesion resembling a subcapsular hemangioma in the spleen, and aneurysmatic dilation of the splenic artery with a diameter of >5 cm. The large size of the aneurysm and the clinical findings were indications for surgical treatment. The patient underwent en bloc resection of the spleen, distal pancreas, and aneurysmatic segment of the splenic artery. The patient remains complication-free 2 months after the operation. Spontaneous rupture is the most important life-threatening complications of giant SAAs. Therefore, all symptomatic patients with SAA should be treated, as well as asymptomatic patients with lesions ≥2 cm, who are pregnant or fertile, have portal hypertension, or are candidates for liver transplantation. Despite advances in endovascular techniques, conventional abdominal surgery remains the gold standard for treatment.

scholarly journals En Masse Resection of Pancreas, Spleen, Celiac Axis, Stomach, Kidney, Adrenal, and Colon for Invasive Pancreatic Corpus and Tail Tumor

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Koray Kutluturk ◽  
Abdul Hamid Alam ◽  
Cuneyt Kayaalp ◽  
Emrah Otan ◽  
Cemalettin Aydin
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Tumor ◽  
Left Renal Vein ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
Celiac Axis ◽  
Left Adrenal Gland ◽  
En Bloc ◽  
Extensive Surgery

Providing a more comfortable life and a longer survival for pancreatic corpus/tail tumors without metastasis depends on the complete resection. Recently, distal pancreatectomy with celiac axis resection was reported as a feasible and favorable method in selected pancreatic corpus/tail tumors which had invaded the celiac axis. Additional organ resections to the celiac axis were rarely required, and when necessary it was included only a single extra organ resection such as adrenal or intestine. Here, we described a distal pancreatic tumor invading most of the neighboring organs—stomach, celiac axis, left renal vein, left adrenal gland, and splenic flexure were treated by en bloc resection of all these organs. The patient was a 60-year-old man without any severe medical comorbidities. Postoperative course of the patient was uneventful, and he was discharged on postoperative day eight without any complication. Histopathology and stage of the tumor were adenocarcinoma and T4 N1 M0, respectively. Preoperative back pain of the patient was completely relieved in the postoperative period. As a result, celiac axis resection for pancreatic cancer is an extensive surgery, and a combined en masse resection of the invaded neighboring organs is a more extensive surgery than the celiac axis resection alone. This more extensive surgery is safe and feasible for selected patients with pancreatic cancer.

En bloc resection in giant bilobed splenic artery aneurysm

2021 ◽  
Vol 14 (9) ◽  
pp. e244319
Author(s):  
Venu Bhargava Mulpuri ◽  
Jayanta Samanta ◽  
Pankaj Gupta ◽  
Vikas Gupta
Keyword(s):  
Early Detection ◽  
Splenic Artery ◽  
Artery Aneurysm ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Morbidity And Mortality ◽  
Splenic Artery Aneurysm ◽  
High Morbidity ◽  
En Bloc ◽  
Distal Pancreas

Giant splenic artery aneurysms are rare and associated with high morbidity and mortality. Early detection is the key to decreasing morbidity and mortality. We present a giant splenic artery aneurysm which was managed by en bloc resection of the spleen, distal pancreas.

scholarly journals The Knack and Pitfall of the Retropancreatic Nerve Plexus Hanging Maneuver for Pancreatoduodenectomy for Pancreatic Head Carcinoma.

2020 ◽  
Author(s):  
Naokazu Chiba ◽  
Shigeto Ochiai ◽  
Takahiro Gunji ◽  
Toshimichi Kobayashi ◽  
Kosuke Hikita ◽  
...  
Keyword(s):  
Pancreatic Head ◽  
Operation Time ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Celiac Axis ◽  
Nerve Plexus ◽  
R0 Resection ◽  
En Bloc ◽  
Hanging Maneuver ◽  
The Right

Abstract Background The efficacy of the hanging maneuver for the retropancreatic nerve plexus (RNP) to enhance the confirmation of the margin status and to facilitate en-bloc resection for pancreatoduodenectomy (PD). In this report, we present the knack and pitfall of the hanging maneuver of the RNP. MethodsThe exit of the hanging maneuver of the RNP is the left part of the superior mesenteric artery (SMA), and the entry is the cranial part of the celiac axis. The entry of the hanging maneuver was connected to the dissection line on the right side of the celiac axis. Thereafter, the tape of the hanging maneuver was pulled to the right side, and the RNP was deployed widely. Finally, the RNP was easily dissected using a sealing device other than IPDA ResultsIt is important to clarify the entrance and exit of the hanging taping in this procedure. This permitted the wide spaces between the SMA, SMV, and the resected side, and it was easier to identify the IPDA. By traction of the hanging maneuver tape, a clear line may be drawn between the resection side and the remaining side. ConclusionsWith the correct implementation of the hanging maneuver, we believe that it would be possible to obtain reliable R0 resection as well as a reduction in blood loss and operation time.

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