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Morphological speculation of the MHPD and related clinical projections
Yue Gao1, Runjing Wang2, Yungang Lai3
1Department of Hepatobiliary Surgery, General Rocket Hospital of Chinese People's Liberation Army, Beijing, People's Republic of China.
Objective:
The concept of mesopancreas has been brought into focus nowadays. Studies on membrane morphology of pancreas are clinically significant in determining an ideal surgical route for a "holy plane". In this paper, we aimed to observe the structure of the peripancreatic membranes and its interactions with adjacent tissues; tentatively put forward the proposition of mesohepatopancreaticoduodenum (MHPD) and explore in depth in surgical local resection.
Methods:
33 cadavers were examined in the experiment, including 30 for gross anatomy and 3 for histological observation after transection. The histological characteristics of the membrane covering the pancreas were proved by Masson and Bielschowsky silver staining and further explored in clinical application and testified in a surgical scenario. All above were carried out through traditional procedures.
Results:
The anterior surface membrane of the pancreas was intact and the posterior portion expanding to the pancreaticoduodenum enclosed the surface of the duodenum and the pancreatic head, which could be easily isolated from the posterior abdominal wall. The posterior surface membrane around the body and tail wrapped the pancreatic parenchyma, which created a soft-tissue window for the posterior abdominal wall. Then, dense connective tissue adhesions were detected between the celiac artery and the superior mesenteric artery.
Conclusions:
The embryonic origin of the mesopancreas and the surgical procedures were reviewed and inspected based on the proposition of MHPD and above results. We hope that this study could stir up our interest in the advancement of imaging diagnoses and minimally invasive surgical treatment of pancreas.
Insights
The study reveals distinct peripancreatic membrane structures, identifying the mesohepatopancreaticoduodenum (MHPD) as a key surgical plane. This anatomical insight aids in planning minimally invasive pancreatic resections.
Area of Science:
- Surgical Anatomy
- Gastrointestinal Surgery
- Histology
Background:
- The mesopancreas concept is gaining attention for its clinical significance in pancreatic surgery.
- Understanding peripancreatic membrane morphology is crucial for defining surgical planes, like the "holy plane".
Purpose of the Study:
- To observe the structure of peripancreatic membranes and their interactions with adjacent tissues.
- To propose the mesohepatopancreaticoduodenum (MHPD) concept.
- To explore the implications of MHPD in surgical local resection of the pancreas.
Main Methods:
- Gross anatomical examination of 33 cadavers (30 gross, 3 histological).
- Histological analysis using Masson and Bielschowsky silver staining.
- Clinical application exploration and surgical scenario validation.
Main Results:
- The anterior pancreatic surface membrane is intact; the posterior portion forms the MHPD, enclosing the duodenum and pancreatic head.
- The posterior membrane around the body and tail creates a "soft-tissue window" to the posterior abdominal wall.
- Dense connective tissue adhesions were noted between the celiac and superior mesenteric arteries.
Conclusions:
- The study reviews the embryonic origin of the mesopancreas and surgical procedures in light of the MHPD proposition.
- Findings support advancements in imaging diagnostics and minimally invasive pancreatic surgery.
- The MHPD concept offers a new perspective for surgical planning and execution in pancreatic resections.
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