Embryologic and anatomic basis of duodenal surgery

Area of Science:

• Surgical Anatomy
• Gastrointestinal Surgery
• Pancreatic Surgery

Background:

• The head of the pancreas, common bile duct, and duodenum are embryologically, anatomically, and surgically interconnected.
• Complete resection of the pancreatic head typically necessitates removal of the duodenum and distal common bile duct due to their shared blood supply.
• Duodenum-preserving pancreatic head resection techniques aim to preserve endocrine function and minimize surgical morbidity.

Purpose of the Study:

• To highlight critical anatomical considerations for surgeons operating on the pancreaticoduodenal region.
• To emphasize the importance of preserving vascular supply to the duodenum and pancreas.
• To review surgical techniques and potential complications associated with pancreatic head resections.

Main Methods:

• Review of anatomical relationships between the pancreas, duodenum, and common bile duct.
• Discussion of surgical procedures such as duodenum-preserving pancreatic head resection and ampullectomy.
• Emphasis on critical surgical steps, including vessel ligation and duct preservation.

Main Results:

• Ampullectomy demonstrates low mortality (<0.4%) and morbidity (<10.0%).
• Ligation of pancreaticoduodenal arteries can lead to pancreatic and duodenal necrosis.
• Accidental ligation of the accessory pancreatic duct of Santorini can be catastrophic, especially when it's the sole pancreatic duct.

Conclusions:

• Meticulous attention to the blood supply of the duodenum and pancreas is paramount in pancreatic head surgery.
• Understanding the anatomy of the gastroduodenal artery and the duct of Santorini is vital for preventing surgical complications.
• Appropriate surgical techniques, including careful mobilization and reconstruction, are essential for successful outcomes.