Intestinal derotation procedure for facilitating pancreatoduodenectomy

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Anatomical Studies

Background:

• Pancreatoduodenectomy (PD) involves technically challenging mesopancreas excision due to complex embryological anatomy.
• Division of the inferior pancreatoduodenal artery (IPDA) during PD is particularly difficult.
• A novel intestinal derotation procedure was developed to address these challenges.

Purpose of the Study:

• To evaluate the efficacy and safety of an intestinal derotation technique in PD.
• To compare perioperative outcomes between the derotation and conventional PD procedures.
• To assess the impact of derotation on mesopancreas excision and IPDA division.

Main Methods:

• Retrospective comparison of perioperative factors in 232 PD cases.
• Two groups: intestinal derotation (n=117) and conventional procedure (n=115).
• Mobilization of small intestine and right colon to reduce intestinal rotation and simplify anatomy.

Main Results:

• The derotation procedure significantly decreased operative time (434 vs 516 min) and blood loss (521 vs 908 mL).
• R0 resection rates tended to increase (90% vs 78%) with the derotation technique.
• Early IPDA division occurred more frequently in the derotation group; complication rates were similar.

Conclusions:

• The intestinal derotation technique is a simple and effective method for PD.
• It facilitates mesopancreas excision and early IPDA division.
• This approach offers improved perioperative efficiency without compromising safety.