Pancreatic Transplant Tecnique

7/23/2019 Pancreatic Transplant Tecnique

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SMAIPDA:

inferior pancreatoduodenal artery

(anterior and posterior arcades)SMA



GDASPDA:



SA



KEY POINTS

TO REMEMBER

Dorsal Pancreatic Artery.

Inferior Pancreatoduodenal Artery.



1. Open abdomen cruciate incision.

2. Open the lesser sac and

inspect the pancreas:- Soft,

- no edema,- no fatty infliltration



3. Open the gastrohepatic

ligament and inspect arterial

anatomy of the liver:

Replacement arteries

4. Identify Common bile

duct and the GDA

5. Identify with vessel

loop Splenic A.



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7. Identify root of the SMA with

vessel loop.

VC Ao

L renal vein

SMA



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12. Cut Portal vein:

Lenght has to be shared for

the liver.

! Landmark before

movilization of the head of

pancreas to avoid short PV

for the pancreas.

13. GIA section 1st portion

of duodenum after Pilorus

and at Treitz.



12. Cut Portal vein:

Lenght has to be shared for

the liver.

! Landmark before

movilization of the head of

pancreas to avoid short PV

for the pancreas.

13. GIA section 1st portion

of duodenum after Pilorus

and at Treitz.



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B. If Liver is retrieved:

- Section SA at origin

“Dorsal pancreatic artery”

- Ligate GDA

14. Arterial sharing:



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B. If Liver IS retrieved:

- Ligate GDA





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B. If Liver IS retrieved:

- Ligate GDA





RIGHT REPLACED HEPATIC ARTERY:

SMA

GDA

rRHA

Lf RV

IMVcanula

The IPDA comes from SMA



RIGHT REPLACED HEPATIC ARTERY:

SMA

IPDA

rRHA

Lf RV

IPDA comes

from the rRHA



ANASTOMOSIS GDA to stump rRHA

GDA rRHA

SMA



GDA

Y-GRAFT

SMA

SA



KY=<XD!D ID<X>KD=DQ! YZ KDXN>K !I[QF

Ao

SA

SMA

Hep A

GDA

SMA

KEEP Aortic patch with

Celiac Trunk and SMAcut Hepatic A.




Ao

SA

SMA

Hep A

GDA

SMA

Section Hep A and SA.

Keep SMA on Aortic

patch




Ao

SA

SMA

Hep A

GDA

SMA



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Pancreatic Transplant Tecnique