SMA first approach Pancreaticoduodenectomy for cancer – should it be standard approach?

Background: pancreaticoduodenectomy (PD) has become the standard treatment for cancer of head of pancrease and periampullary malignancies. Recently superior mesenteric artery (SMA) first approach has shown to have several advantages over the conventional superior mesenteric vein (SMV) first approac...

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Autores principales:	Binay Thakur, Mukti Devkota, Di Yonghui, Yogesh Regmi, Durga Khanal, Kopila Khadaka
Formato:	article
Lenguaje:	EN
Publicado:	Society of Surgeons of Nepal 2016
Materias:	pancreaticoduodenectomy superior mesenteric artery hanging maneuver Surgery RD1-811
Acceso en línea:	https://doaj.org/article/6473b948f0ef495da1f35e10773bcbe3
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spelling	oai:doaj.org-article:6473b948f0ef495da1f35e10773bcbe32021-12-05T19:16:40ZSMA first approach Pancreaticoduodenectomy for cancer – should it be standard approach?10.3126/jssn.v18i3.152891815-39842392-4772https://doaj.org/article/6473b948f0ef495da1f35e10773bcbe32016-07-01T00:00:00Zhttps://www.nepjol.info/index.php/JSSN/article/view/15289https://doaj.org/toc/1815-3984https://doaj.org/toc/2392-4772 Background: pancreaticoduodenectomy (PD) has become the standard treatment for cancer of head of pancrease and periampullary malignancies. Recently superior mesenteric artery (SMA) first approach has shown to have several advantages over the conventional superior mesenteric vein (SMV) first approach. We present our initial experience with SMA first approach for PD. Methods: Thirteen patients undergoing SMA first PD during year 2014-2015 (1 year) were prospectively studied. A posterior approach with “hanging maneuver” was used to identify SMA first and the resectibility was confirmed. Inferior pancreaticoduodenal artery (IPDA) was ligated before the division of pancreatic neck. Duct to mucosa pancreaticojejunostomy followed by hepaticojejunostomy and gastrojejunostomy was performed. Results: patients with mean age of 53 years presented with abdominal pain and jaundice (100%). Tumors were of periampullary region in 10 cases and of head of pancrease in three cases. Two patients required partial SMV wall resection with tangential repair. Mean operating time, blood loss and postoperative stay was 304 minutes, 380 ml and 14 days, respectively. Replaced/ aberrant right hepatic artery from SMA was observed in 38% cases. Mean number of dissected nodes was 16. R0 resection was achieved in 100% cases. There was one postoperative mortality (7.7%) and minor complications were noted in 46% cases. Conclusion: SMA first PD helps to properly identify and control anomalous or accessory right hepatic artery arising from SMA, minimizes intraoperative bleeding due to proper control. Binay ThakurMukti DevkotaDi YonghuiYogesh RegmiDurga KhanalKopila KhadakaSociety of Surgeons of Nepalarticlepancreaticoduodenectomysuperior mesenteric arteryhanging maneuverSurgeryRD1-811ENJournal of Society of Surgeons of Nepal, Vol 18, Iss 3 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	pancreaticoduodenectomy superior mesenteric artery hanging maneuver Surgery RD1-811
spellingShingle	pancreaticoduodenectomy superior mesenteric artery hanging maneuver Surgery RD1-811 Binay Thakur Mukti Devkota Di Yonghui Yogesh Regmi Durga Khanal Kopila Khadaka SMA first approach Pancreaticoduodenectomy for cancer – should it be standard approach?
description	Background: pancreaticoduodenectomy (PD) has become the standard treatment for cancer of head of pancrease and periampullary malignancies. Recently superior mesenteric artery (SMA) first approach has shown to have several advantages over the conventional superior mesenteric vein (SMV) first approach. We present our initial experience with SMA first approach for PD. Methods: Thirteen patients undergoing SMA first PD during year 2014-2015 (1 year) were prospectively studied. A posterior approach with “hanging maneuver” was used to identify SMA first and the resectibility was confirmed. Inferior pancreaticoduodenal artery (IPDA) was ligated before the division of pancreatic neck. Duct to mucosa pancreaticojejunostomy followed by hepaticojejunostomy and gastrojejunostomy was performed. Results: patients with mean age of 53 years presented with abdominal pain and jaundice (100%). Tumors were of periampullary region in 10 cases and of head of pancrease in three cases. Two patients required partial SMV wall resection with tangential repair. Mean operating time, blood loss and postoperative stay was 304 minutes, 380 ml and 14 days, respectively. Replaced/ aberrant right hepatic artery from SMA was observed in 38% cases. Mean number of dissected nodes was 16. R0 resection was achieved in 100% cases. There was one postoperative mortality (7.7%) and minor complications were noted in 46% cases. Conclusion: SMA first PD helps to properly identify and control anomalous or accessory right hepatic artery arising from SMA, minimizes intraoperative bleeding due to proper control.
format	article
author	Binay Thakur Mukti Devkota Di Yonghui Yogesh Regmi Durga Khanal Kopila Khadaka
author_facet	Binay Thakur Mukti Devkota Di Yonghui Yogesh Regmi Durga Khanal Kopila Khadaka
author_sort	Binay Thakur
title	SMA first approach Pancreaticoduodenectomy for cancer – should it be standard approach?
title_short	SMA first approach Pancreaticoduodenectomy for cancer – should it be standard approach?
title_full	SMA first approach Pancreaticoduodenectomy for cancer – should it be standard approach?
title_fullStr	SMA first approach Pancreaticoduodenectomy for cancer – should it be standard approach?
title_full_unstemmed	SMA first approach Pancreaticoduodenectomy for cancer – should it be standard approach?
title_sort	sma first approach pancreaticoduodenectomy for cancer – should it be standard approach?
publisher	Society of Surgeons of Nepal
publishDate	2016
url	https://doaj.org/article/6473b948f0ef495da1f35e10773bcbe3
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SMA first approach Pancreaticoduodenectomy for cancer – should it be standard approach?

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