THE INFRAPYLORIC ARTERY AND CEPHALIC PANCREATICODUODENECTOMY WITH PYLORUS PRESERVATION - PRELIMINARY-STUDY

Cephalic pancreatoduodenectomy (CPD) with pylorus preservation has bee n suggested to improve the functional and nutritional result of surger y. At operation, the first two centimeters of the duodenum are preserv ed, the vascular arch of the lesser gastric curvature is saved and the right gastroepiploic artery is resected at its origin. The aim of thi s study on 15 fresh cadavers was to determine the origin of the vascul arization of the remaining duodenum and also the possibilities of pres erving an optimal vascularization after CPD and pylorus pre: servation . All of the arteries supplying the remaining duodenum and arising eit her from the fight gastric artery or the right gastroepiploic artery w ere identified. The distances between the origin of the infrapyloric a rtery and the termination of the gastroduodenal artery on the cranial and ventral pancreaticoduodenal artery and the left gastroepiploic art ery were measured. At CPD with pylorus preservation, the study demonst rated that: 1) the cranial side of the remaining duodenum remains vasc ularized in 80% of the cases by one or two supraduodenal branches comi ng from the fight gastric artery; 2) ligation of the right gastroepipl oic artery eliminates all vascular supply to the caudal side of the re maining duodenum in almost half of the cases; 3) in these cases, the d issection of the bifurcation of the gastroduodenal artery and the vasc ular section beyond the origin of the infrapyloric artery allowed a di rect vascular supply to the remaining duodenum to be preserved.