[Progress in operative techniques in pancreas transplantation]

Progress in operative techniques in pancreas transplantation.Pancreas transplantation has become a clinically established therapeutic procedure. The astonishing clinical success of pancreas transplantation resulted not only from new immunosuppressive strategies, but also from a remarkable progress in operative techniques. Pancreas segmental transplantation has been replaced by whole pancreas/duodenal transplantation. The exocrine secretion of the pancreas graft is not drained anymore into the bladder, but into the small intestine. Drainage of the venous blood from the graft containing high amounts of insulin is restored more and more not directly into the systemic venous circulation, but rather into the portal venous system. Thus, pancreas transplantation with enteral and portal drainage can be regarded as an operative technique which guarantees for the first time a totally physiologic situation in respect to the exocrine as well as endocrine secretions of the pancreas graft.