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  • Title: Technical Details of an Anterior Approach to the Superior Mesenteric Artery During Pancreaticoduodenectomy.
    Author: Inoue Y, Saiura A, Tanaka M, Matsumura M, Takeda Y, Mise Y, Ishizawa T, Takahashi Y.
    Journal: J Gastrointest Surg; 2016 Oct; 20(10):1769-77. PubMed ID: 27456019.
    Abstract:
    INTRODUCTION: Use of central vascular ligation during dissection around the superior mesenteric artery (SMA) in pancreaticoduodenectomy (PD) for periampullary malignancies has rarely been documented. METHODS: We developed the SMA hanging technique (SHT) to facilitate central vascular ligation during PD. Briefly, SMA dissection was initiated using the supracolic anterior approach, followed by left-sided dissection. The SMA was taped under finger guidance immediately after right-sided dissection. The ligament of Treitz was detached from the SMA during left-sided dissection, facilitating adequate lymph node dissection while preserving the nerve plexus around the SMA. Forty-seven consecutive patients who underwent PD for periampullary malignancies were divided into two groups: 23 underwent SHT and 24 underwent conventional dissection. Patients' clinical results were assessed to evaluate the feasibility and validity of SHT. RESULTS: Blood loss volume, operation duration, and the incidence of bleeding during SMA dissection were significantly lower in the SHT group than in the conventional group. The short-term and oncological results were similarly acceptable in both groups. CONCLUSIONS: SHT is a feasible and safe technique with acceptable short-term outcomes. We propose the use of this procedure to standardize en bloc dissection around the SMA.
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