scholarly journals Surgical glance at pancreatic arterial anatomy

2021 ◽  
Vol 26 (3) ◽  
pp. 112-122
Author(s):  
A. G. Kriger ◽  
N. A. Pronin ◽  
M. V. Dvukhzhilov ◽  
D. S. Gorin ◽  
A. V. Pavlov ◽  
...  
Keyword(s):  
Portal Vein ◽  
Pancreatic Fistula ◽  
Computer Tomography ◽  
Mesenteric Artery ◽  
Splenic Artery ◽  
Postoperative Pancreatic Fistula ◽  
Gastroduodenal Artery ◽  
Dorsal Pancreatic Artery ◽  
Pancreatic Artery ◽  
Arterial Anatomy

Aim. Study of anatomical variations of the pancreatic neck blood supply, which may affect the results of pancreaticoduodenectomy.Material and methods. Anatomic characteristics of arterial blood supply of pancreas were studied in 42 autopsied cases, who died from diseases not associated with abdominal organs failure. Clinical part of our study included 62 patients. Arterial anatomy was examined during early arterial phase of computer tomography. Options of the origin of the dorsa pancreatic artery were noted. All patients had “soft” pancreas confirmed by morphological examination and computer tomography. Main group included 20 patients. Dissection of the pancreas during pancreatoduodenectomy in this group were performed 10–15 mm left of portal vein confluence. Control (retrospective) group included 42 patients performed standard procedure, when pancreas was dissected above the portal vein confluence.Results. It was found that the neck of pancreas was supplied from dorsal pancreatic artery, found in all specimens. In 76% of cases it was a branch of splenic artery, in other cases – a branch of superior mesenteric artery. CT scan revealed the dorsal pancreatic artery in 54 (87.1%) people, in 8 patients the artery could not be identified. The dorsal pancreatic artery was a branch of the splenic artery in 64.8% of cases. In other cases it was a branch of the superior mesenteric artery, common hepatic artery, gastroduodenal artery and middle colon artery. If the dorsal pancreatic artery was a branch of the superior mesenteric, common hepatic, gastroduodenal artery, it was transected during lymphadenectomy. This led to higher frequency of postoperative pancreatic fistula.Conclusion. Localization of dorsal pancreatic artery must be taken into account during the pancreatoduodenectomy. That allows to decrease probability of postoperative pancreatic fistula.

scholarly journals The main arterial vessels of pancreatic isthmus and their importance in surgery

2020 ◽  
Vol 101 (1) ◽  
pp. 53-57
Author(s):  
S V Tarasenko ◽  
P V Tarakanov ◽  
A A Natalskiy ◽  
A V Pavlov ◽  
E A Dronova
Keyword(s):  
Cross Section ◽  
Blood Supply ◽  
Splenic Artery ◽  
Gastroduodenal Artery ◽  
Lower Edge ◽  
The Third ◽  
Dorsal Pancreatic Artery ◽  
Pancreatic Artery ◽  
Place Of Origin ◽  
Point Of Departure

Aim. To optimize the ways of cross-section of the pancreas in its isthmus, taking into account the topography of the main arteries of this area. Methods. 43 organocomplexes representing pancreas with duodenum were studied. Injection mass was injected into arterial vessels with subsequent fixation in 4% formalin solution and final preparation of complexes. The main arteries of the isthmus of the pancreas, their places of origin and topography were evaluated. Results. The main arteries of the isthmus of the pancreas are the peripancreatic artery and the additional artery of the isthmus of the pancreas. Peripancreatic artery was observed in 97.67% of cases; it departed from the dorsal pancreatic artery in 93% of cases, from the third branch of the splenic artery in 7% of cases. The diameter at the point of departure was 1.610.12 mm. In 95.3%, the artery passed along the lower edge of pancreatic isthmus. The peripancreatic artery was connected to the gastroduodenal artery or its branches. The diameter of peripancreatic artery at the junction was 1.550.1 mm. An additional artery of the isthmus of the pancreas was found in 93% of cases. In 76.74% it departed from the basin of the dorsal pancreatic artery, in 9.3% from another branch of the splenic artery, in 13.95% directly from the splenic artery itself. The diameter at the point of departure was 1.060.1 mm. It passed along the upper edge of pancreatic isthmus and connected to the pool of the gastroduodenal artery. The diameter at the junction was 0.980.1 mm. The diameter of peripancreatic artery was 1.950.05 mm in the trunk type versus 1.480.05 mm in the branched type of blood supply. The diameter of the additional artery of the isthmus of the pancreas had no pronounced changes depending on the type of blood supply to the pancreas. Conclusion. The topography of the main arteries of the isthmus of the pancreas is constant and does not depend on their diameter and place of origin. The most vascularized zones of the isthmus of the pancreas are its lower and upper edges.

Pancreaticogastrostomy Prevents Postoperative Pancreatic Fistula of Portal Annular Pancreas During Pancreaticoduodenectomy

2016 ◽  
Vol 101 (11-12) ◽  
pp. 550-553
Author(s):  
Ippei Matsumoto ◽  
Keiko Kamei ◽  
Shumpei Satoi ◽  
Takuya Nakai ◽  
Yoshifumi Takeyama
Keyword(s):  
Portal Vein ◽  
Pancreatic Fistula ◽  
Dorsal Surface ◽  
Uncinate Process ◽  
Postoperative Pancreatic Fistula ◽  
The Body ◽  
Annular Pancreas ◽  
Exocrine Function ◽  
Portal Annular Pancreas ◽  
Increased Risk

Portal annular pancreas (PAP) is an asymptomatic congenital pancreatic anomaly in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein and or the superior mesenteric vein. During pancreaticoduonectomy (PD), the presence of PAP significantly increased risk for postoperative pancreatic fistula (POPF) because specific management of 2 pancreatic resection planes with 1 or 2 pancreatic ducts is required for pancreatico-intestinal reconstruction. To reduce the risk of POPF, a shift of the resection plain to the left for 1 anastomosis is recommended. We report a case of PAP that was successfully performed PD with pancreaticogastrostomy (PG). PG was conducted with invagination of the 2 resected pancreatic planes together into the stomach to minimize resected volume of the pancreas. A 78-year-old male patient with PAP underwent PD due to a duodenal adenocarcinoma. Intraoperatively, the uncinate process extended extensively behind the portal vein and fused with the dorsal surface of the pancreatic body above the splenic vein. For pancreatico-intestinal reconstruction, PG was performed with invagination of the 2 resected pancreatic planes together into the stomach. The postoperative course was uneventful, and he was discharged on postoperative day 12. Endocrine and exocrine function of the pancreas were maintained well at 10 months after surgery. PG is one of the useful choices for patients with PAP to prevent POPF while maintaining the pancreatic endocrine and exocrine function after PD.

scholarly journals Abdominal hemodynamics in patients with visceroptosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Ljaljukov ◽  
E Loginova ◽  
G Nechaeva ◽  
I Druk ◽  
A Semenkin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Portal Vein ◽  
Superior Mesenteric Artery ◽  
Hepatic Artery ◽  
Mesenteric Artery ◽  
Splenic Artery ◽  
Digestive System ◽  
Common Hepatic Artery ◽  
Postprandial Period ◽  
The Common

Abstract Background Abdominal circulation plays the important physiological role for structure and function of the digestive system, maintenance of nutrient homeostasis. Purpose To study the features of abdominal hemodynamics in patients with visceroptosis. Methods We studied 69 patients (mean age 22.28±3.7 years) with splanchnoptosis (visceroptosis) and 52 age- and sex- matched patients without splanchnoptosis (controls). Exclusion criteria: a history of digestive system surgery of taking blood circulation activating drugs. Doppler ultrasonography of the common hepatic artery, splenic artery, superior mesenteric artery, portal vein was performed on an empty stomach and 30 minutes after a food sample (standardized for proteins (14 g), fats (10 g) and carbohydrates (45 g)) using the Sonoace-8000 ultrasound scanner (Medison, South Korea). The data were analyzed using the Statistica-6 packages. Results There were no differences in hemodynamic parameters of fasting abdominal blood flow (ABF). After a food testing, in the postprandial period the ABF in all vessels in patients with splanchnoptosis was lower than in controls: the portal vein blood flow (BF) 1124,0 [1030,0–1419,0] ml/min vs 1373,0 [1136,0–1567,5] ml/min respectively (U=433,5; Z=−2,1; p=0,0342); the common hepatic artery BF 341,0 [295,0–394,0] ml/min vs 412,0 [331,0–521,0] ml/min respectively (U=335,0; Z=−2,3; p=0,0218); the splenic artery BF 396,0 [292,0–538,0] ml/min vs 502,0 [394,0–594,0] ml/min respectively (U=328,0; Z=−2,1; p=0,0399); the superior mesenteric artery BF 988,0 [837,0–1272,0] ml/min vs 1136,5 [992,0–1465,0] ml/min respectively (U=1625,5; Z=−2,2; p=0,0314). Changes in ABF were correlated with splanchnoptosis: the portal vein BF with any ptosis (rs=−0,21; p<0.05), the common hepatic artery BF with gastroptosis (rs=−0,38; p<0.05), the superior mesenteric artery BF with colonoptosis (rs=−0,86; p<0.05). The peripheral vascular resistance was correlated with the common hepatic artery BF (rs=−0,46; p<0.05), with the splenic artery BF (rs=−0,33; p<0.05) and with the superior mesenteric artery BF (rs=−0.79; p<0.05). Conclusions Patients with splanchnoptosis in the postprandial period have low volumetric BF in abdominal aorta vessels. This can be associated with the length of the mesenteric vessels, which undergoes the greatest changes in splanchnoptosis. Food testing reveals latent BF deficit in patients with splanchnoptosis. FUNDunding Acknowledgement Type of funding sources: None.

Non-operative Risk Factors and the Implications of Sandostatin for Postoperative Pancreatic Fistula in Malignant Pancreatic Surgery

2018 ◽  
Vol 68 (12) ◽  
pp. 2875-2878
Author(s):  
Delia Rusu Andriesi ◽  
Ana Maria Trofin ◽  
Irene Alexandra Cianga Spiridon ◽  
Corina Lupascu Ursulescu ◽  
Cristian Lupascu
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Postoperative Pancreatic Fistula ◽  
University Center ◽  
Preoperative Hemoglobin ◽  
Term Administration ◽  
Postoperative Administration

Pancreatic fistula is the most frecquent and severe postoperative complication after pancreatic surgery, with impressive implications for the quality of life and vital prognosis of the patient and for these reasons it is essential to identify risk factors. In the current study, who included 109 patient admitted to a single university center and who underwent pancreatic resection for malignant pathology, we assessed the following factors as risk factors: age, sex, preoperative hemoglobin value, preoperative total protein value, obesity and postoperative administration of sandostatin. Of the analyzed factors, it appears that only obesity and long-term administration of sandostatin influences the occurrence of pancreatic fistula.

scholarly journals Predictive Significance of C-reactive Protein-to-albumin Ratio for Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

2019 ◽  
Vol 39 (11) ◽  
pp. 6283-6290 ◽  
Author(s):  
TERUHISA SAKAMOTO ◽  
YAKUKI YAGYU ◽  
EI UCHINAKA ◽  
MASAKI MORIMOTO ◽  
TAKEHIKO HANAKI ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein

Pancreatic thickness as a predictive factor for postoperative pancreatic fistula after distal pancreatectomy using an endopath stapler

Surgery Today ◽  
2012 ◽  
Vol 43 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Keiichi Okano ◽  
Minoru Oshima ◽  
Keitaro Kakinoki ◽  
Naoki Yamamoto ◽  
Shintaro Akamoto ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Predictive Factor ◽  
Postoperative Pancreatic Fistula ◽  
Pancreatic Thickness

scholarly journals Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Runwen Liu ◽  
Yunqiang Cai ◽  
He Cai ◽  
Yajia Lan ◽  
Lingwei Meng ◽  
...  
Keyword(s):  
Prediction Model ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
C Reactive Protein ◽  
Dynamic Prediction ◽  
Albumin Ratio ◽  
Drainage Fluid ◽  
Reactive Protein ◽  
Baseline Factors

Abstract Background With the recent emerge of dynamic prediction model on the use of diabetes, cardiovascular diseases and renal failure, and its advantage of providing timely predicted results according to the fluctuation of the condition of the patients, we aim to develop a dynamic prediction model with its corresponding risk assessment chart for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy by combining baseline factors and postoperative time-relevant drainage fluid amylase level and C-reactive protein-to-albumin ratio. Methods We collected data of 251 patients undergoing LPD at West China Hospital of Sichuan University from January 2016 to April 2019. We extracted preoperative and intraoperative baseline factors and time-window of postoperative drainage fluid amylase and C-reactive protein-to-albumin ratio relevant to clinically relevant pancreatic fistula by performing univariate and multivariate analyses, developing a time-relevant logistic model with the evaluation of its discrimination ability. We also established a risk assessment chart in each time-point. Results The proportion of the patients who developed clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy was 7.6% (19/251); preoperative albumin and creatine levels, as well as drainage fluid amylase and C-reactive protein-to-albumin ratio on postoperative days 2, 3, and 5, were the independent risk factors for clinically relevant postoperative pancreatic fistula. The cut-off points of the prediction value of each time-relevant logistic model were 14.0% (sensitivity: 81.9%, specificity: 86.5%), 8.3% (sensitivity: 85.7%, specificity: 79.1%), and 7.4% (sensitivity: 76.9%, specificity: 85.9%) on postoperative days 2, 3, and 5, respectively, the area under the receiver operating characteristic curve was 0.866 (95% CI 0.737–0.996), 0.896 (95% CI 0.814–0.978), and 0.888 (95% CI 0.806–0.971), respectively. Conclusions The dynamic prediction model for clinically relevant postoperative pancreatic fistula has a good to very good discriminative ability and predictive accuracy. Patients whose predictive values were above 14.0%, 8.3%, and 7.5% on postoperative days 2, 3, and 5 would be very likely to develop clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy.

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