Surgical Anatomy of the Pancreas

In gastroenterological surgery, pancreatoduodenectomy is a difficult operation and requires solid anatomical knowledge and skill to perform the procedure itself and be safely completed. Venous bleeding because of the venous congestion of the pancreatic head and duodenum may be encountered when the vein that flows from the pancreatic head to the superior mesenteric vein is cut when performing a pancreatoduodenectomy, and this may hinder subsequent procedures. It is possible to prevent the congestion of the pancreatic head and duodenum by dealing with the incoming artery from the pancreatic head early in the operation. This incoming artery is the inferior pancreatic duodenal artery. Although the bifurcation of the inferior pancreatic duodenal artery takes multiple forms, an artery-first approach is a useful method for safely performing surgery because it allows confirmation prior to surgery. Using this method, not only can the amount of intraoperative bleeding be reduced but dissection of the lymph nodes and nerve plexus around the superior mesenteric artery can also be safely and reliably performed for the cancer of the pancreatic head. In this study, we report our results on the anatomy of the veins and arteries of the pancreatic head and duodenum based on multidetector computed tomography imaging, which is useful when performing a pancreatoduodenectomy.