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Operative Technique |

Pylorus-Preserving Pancreaticoduodenectomy With Complete Preservation of the Pyloroduodenal Blood Supply and Innervation

Jeffrey M. Gauvin, MD; Juan M. Sarmiento, MD; Michael G. Sarr, MD
Arch Surg. 2003;138(11):1261-1263. doi:10.1001/archsurg.138.11.1261.
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Pylorus-preserving pancreaticoduodenectomy is an accepted treatment for benign and malignant diseases of the pancreas. Some element of delayed gastric emptying affects as many as 46% of patients.1,2 Although usually transient, delayed gastric emptying may extend length of hospital stay and persist for several weeks. In addition to pancreatic anastomotic leaks,3 reduced blood flow and compromised innervation to the antral-pyloric pump mechanism have been implicated as causes.46

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Figure 1.

Operative view of the anterior side of the stomach (thick black arrow), the fully preserved gastrohepatic ligament (thin black arrow), and the duodenal transection (thin white arrow). The thick white arrow indicates the pylorus.

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Figure 2.

Operative view of the posterior side of the distal lesser curvature of the stomach retracted anteriorly, preserved gastroduodenal artery (small white arrows), common bile duct (large white arrow), and superior mesenteric vein (black arrow).

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Figure 3.

Preservation of the gastroduodenal artery (GDA) as viewed from the anterior surface of the pancreas. Dissection proceeds distal to the origin of the right gastroepiploic artery (RGEA), which is preserved. The superior pancreaticoduodenal artery (SPDA) is ligated and divided at its origin. The branches to the duodenum from the GDA are carefully preserved (inset).

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Figure 4.

The common bile duct and portal vein are approached from the right, behind the duodenum (arrow), thus preserving all neurovascular tissue along the lesser curvature of the stomach.

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