First jejunal vein oriented mesenteric excision for pancreatoduodenectomy

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Anatomical Studies

Background:

• Pancreaticoduodenectomy (PD) involves challenging dissections of the pancreatic head from the superior mesenteric vein (SMV) and artery (SMA), often leading to significant bleeding due to pancreatic head congestion.
• The traditional
• SMA-first

Purpose of the Study:

• To evaluate the efficacy of a new surgical technique, first jejunal vein oriented mesenteric excision (FME), in reducing intraoperative bleeding during pancreaticoduodenectomy (PD).
• To compare the perioperative outcomes of FME-based PD with standard PD procedures.

Main Methods:

• The FME approach prioritizes the identification and dissection of the jejunal vein, a common bleeding source, before separating the pancreatic head from the SMV and SMA.
• The mesoduodenum, including the inferior pancreaticoduodenal arteries (IPDAs), was completely divided early in the procedure.
• Perioperative outcomes were compared between patients undergoing FME-based PD and standard PD. Computed tomography was used to analyze the spatial characteristics of the first jejunal vein (FJV).

Main Results:

• FME-based PD resulted in significantly lower intraoperative blood loss (569 ml) compared to conventional PD (1094 ml) (P = 0.0315).
• Analysis of the first jejunal vein (FJV) revealed a median proximity of 0 mm to the middle colic artery and the third portion of the duodenum.
• The FJV was predominantly located posterior to the SMA, but anterior positioning was observed in 16.7% of cases.

Conclusions:

• The first jejunal vein oriented mesenteric excision (FME) technique is effective in minimizing intraoperative bleeding during pancreaticoduodenectomy.
• FME offers a valuable alternative for improving surgical safety and reducing blood loss in PD procedures.