[Cephalic duodenopancreatectomy in periampullary tumours. Dissection of the superior mesenteric artery as aninitial approach. Description of the technique and an assessment of our initial experience].

Autor: Figueras J; Sección de Cirugía Hepatobiliar y Pancreática, Hospital Dr Josep Trueta, Girona, España. info@jfigueras.net, Codina-Barreras A, López-Ben S, Maroto A, Torres-Bahí S, González HD, Albiol M, Falgueras L, Pardina B, Soriano J, Codina-Cazador A
Jazyk: Spanish; Castilian
Zdroj: Cirugia espanola [Cir Esp] 2008 Apr; Vol. 83 (4), pp. 186-93.
DOI: 10.1016/s0009-739x(08)70545-1
Abstrakt: Introduction: Pancreatoduodenectomy (PD) with initial dissection of the superior mesenteric artery (SMA) has been described as a useful technical variant to reduce blood loss and to avoid an unnecessary intervention in those cases with arterial involvement.
Objectives: To analyse the results of two recent technical modifications of PD introduced by our group: initial dissection of SMA and antecolic gastroenterostomy.
Patients and Method: Patients were divided into two groups: with and without initial dissection of the SMA. The results were also analysed according to the type of gastric reconstruction. Perioperative and long-term results are compared.
Results: The overall mortality was 5%, with no significant differences between the initial SMA dissection and conventional PD. The transfusion rate (p < 0.001), the volume of blood products transfused (p = 0.001), and the overall complication rate were lower (p = 0.01) in the initial SMA dissection group. Also the postoperative hospital stay was significantly lower (p Conclusions: Initial SMA dissection PD is a safe technique. The transfusion rate, morbidity and postoperative hospital stay are better when compared with conventional CPD. When an antecolic duodenal-jejunal reconstruction is associated, delayed gastric emptying cases are less frequent.
Databáze: MEDLINE
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