T. Berney et al., THE ROLE OF REVASCULARIZATION IN CELIAC OCCLUSION AND PANCREATICODUODENECTOMY, The American journal of surgery, 176(4), 1998, pp. 352-356
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.