Combined Venous and Arterial Reconstruction in the Triangle Area After Total Pancreatoduodenectomy

Is the Anatomical Sequence of Gastric and Biliary Anastomosis in the Pancreatoduodenectomy Reconstruction the Cause of an Increase in the Incidence of Cholangitis? A Technical Variant Presentation and Initial Results

“…Four patients had adenocarcinoma of the pancreas head, one a primary lymphoma, INTRODUCTION R esearchers like Codevilla (1878), Kausch (1912), Whipple (1938 and1944), Cattell (1943), and Child (1944), to name a few, have proposed techniques for the reconstruction of different continuities after pancreatoduodenectomy (PD, with an intention to reduce complications such as the number of postoperative pancreatic fistula, delayed gastric evacuation, and hemorrhage with such modifications. These proposed techniques include a single jejunal loop (with or without Braun anastomosis), Roux-en-Y with one loop as alimentary anastomosis and one loop as biliary and pancreatic anastomosis, Roux-en-Y with one loop as pancreatic anastomosis and one loop as biliary and gastric, pancreaticogastric anastomosis, pylorus preserve PD, and the elevation of the jejunal loop in a transmesocolic way 2,7,8,15,23,24 .…”

A more radical perspective on surgical approach and outcomes in pancreatic cancer—a narrative review

“…Mode of dissection follows what was later described for other pancreatic surgeries. Triangle dissection, combined with complex vascular resections are often performed as depicted in this case after neoadjuvant therapy (90). A particular issue in this operation is pronounced devascularization of the stomach and risk of gastric complications.…”