TITLE:
Early Ligation of the Inferior Pancreaticoduodenal Artery Using Intraoperative Ultrasonography during Pancreaticoduodenectomy
AUTHORS:
Takamitsu Sasaki, Daisuke Kato, Satoshi Shinya, Kanefumi Yamashita, Ryo Nakashima, Hironari Shiwaku, Yasushi Yamauchi, Tomoaki Noritomi, Yuichi Yamashita
KEYWORDS:
Intraoperative Bleeding, Early Ligation, Inferior Pancreaticoduodenal Artery, Pancreaticoduodenectomy, Ultrasonography
JOURNAL NAME:
Surgical Science,
Vol.6 No.2,
February
10,
2015
ABSTRACT: Background: While the safety of
pancreaticoduodenectomy (PD) has improved, the high level of difficulty
associated with this operation means that the procedure carries a high
mortality rate compared to other gastrointestinal operations. Various trials
have been implemented in efforts to reduce the incidence of complications after
PD. In particular, a large amount of intraoperative bleeding and the use of red
blood cell transfusions are reportedly risk factors for postoperative
complications after PD. Aim: In an attempt to reduce the amount of
intraoperative bleeding during PD, consideration was given to the anatomical
characteristics of the region of the pancreatic head, and the gastroduodenal
artery (GDA) and inferior pancreaticoduodenal artery (IPDA) were ligated in
advance of separating the head from the portal vein. We herein report the use
of ultrasonography during PD to facilitate the early identification and
ligation of the IPDA. Case Presentation: A 72-year-old female was diagnosed
with pancreatic cancer and underwent pylorus-preserving pancreatoduodenectomy.
We used ultrasonography during the operation to initially identify the IPDA and
then ligate it in advance, after which the GDA was ligated before separating
the pancreatic head from the superior mesenteric artery and portal vein.
Identification of the IPDA was performed with the SMA as a guide using
ultrasonography in Doppler mode. The amount of intraoperative bleeding was 235
ml. The patient left the hospital without any postoperative complications and
has since demonstrated a good postoperative course, with no evidence of
recurrent disease. Conclusions: Early ligation of the IPDA using intraoperative
US is non-invasive and makes it simple to identify the IPDA. This method may be
a useful technique for reducing intraoperative bleeding during the normal
course of PD procedures.