Pancreatoduodenectomy in which dissection of the efferent arteries of the head of the pancreas is performed first

Background/Purpose: Pancreatoduodenectomy (PD) is one of the most difficult operations in gastrointestinal surgery. Standard PD ligates and cuts superior mesenteric vein (SMV) branches after the removal of the pancreas head, which leads to congestion and bleeding of these veins. Methods: In this study, we modified the standard PD and first ligated the efferent vessels (arteries); namely, the gastroduodenal artery and inferior pancreatoduodenal artery (IPDA), before ligating and cutting the corresponding afferent vessels (veins) of the pancreas head. By doing this, congestion of these veins was relieved and bleeding from the resected surface was substantially prevented. Thirty-six patients (18 underwent standard PD and 18 had modified PD) formed the study population. Results: The amount of bleeding in the modified PD group was significantly lower than that in the standard PD group. (678 ± 329 g vs 1225 ± 375 g, respectively; P < 0.05) However, no difference in operation time was found between the two groups. Conclusions: We believe this modified PD procedure is valuable to enable the safe performance of PD.