Secondary pancreaticoduodenectomy was performed in 2 patients, 1 who had undergone proximal gastrectomy for a gastric carcinoma and 1 who had undergone subtotal esophagectomy with stomach tube reconstruction for an inferior thoracic esophageal carcinoma. To prevent ischemia and congestion of the remnant stomach, the inflow and outflow pathways to the stomach, such as the right gastroepiploic artery and vein, were preserved. In this article, we describe the preservation procedures and discuss the problems of the secondary abdominal surgical procedure.
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Intraoperative view, including a photograph (A) and schema (B), after removal of the specimen with preservation of the right gastroepiploic artery (RGEA) (arrowheads) and right gastroepiploic vein (RGEV) (arrows) in case 1. PHA indicates proper hepatic artery; PV, portal vein; IVC, inferior vena cava; GDA, gastroduodenal artery; and SMV, superior mesenteric vein.
Intraoperative view, including a photograph (A) and schema (B), after removal of the specimen with preservation of the right gastroepiploic artery (RGEA) (yellow arrowheads), right gastroepiploic vein (RGEV) (yellow arrows), and right gastric vein (RGV) (white arrowheads) in case 2. CBD indicates common bile duct; PHA, proper hepatic artery (white arrow); PV, portal vein; IVC, inferior vena cava; ARCV, accessory right colic vein (black arrows); ARCA, accessory right colic artery; CHA, common hepatic artery; and GDA, gastroduodenal artery.
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