THE ROLE OF REVASCULARIZATION IN CELIAC OCCLUSION AND PANCREATICODUODENECTOMY

BACKGROUND: Performance of pancreatoduodenectomy involves sacrifice of the gastroduodenal artery (GDA), which poses an ischemic threat to th e liver, stomach, pancreas, and various anastomoses in patients with c eliac trunk occlusion. METHODS: A survey was conducted in surgical cen ters with expertise in the field of pancreatic surgery. Detailed infor mation was collected from 17 institutions worldwide. Fifteen patients with celiac trunk obstruction were identified. The indication for rese ction was periampullary tumor in 10 cases and chronic pancreatitis in 5. RESULTS: The cause of occlusion was atheromatous disease in 13 case s and arcuate ligament in 2. Trial clamping of the GDA was done in 11 patients, and provoked obvious ischemia in 4. Six patients underwent v ascular procedures: the arcuate ligament was severed in 2 cases, the G DA was preserved in 2 cases of chronic pancreatitis, an aorto-hepatic bypass was performed in 1 case, and the celiac trunk was reimplanted i n 1 case. Complications occurred in 5 patients, with 2 fatalities. CON CLUSIONS: Occlusion of the celiac trunk in patients undergoing pancrea toduodenectomy rarely leads to significant problems. Trial clamping of the GDA is required to assess the need for revascularization, (C) 199 8 by Excerpta Medica, inc.