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The role of revascularization in celiac occlusion and pancreatoduodenectomy
T Berney1, R Pretre, G Chassot
1Clinic of Digestive Surgery, Geneva University Hospital, Switzerland.
Insights
Celiac trunk occlusion rarely complicates pancreatoduodenectomy. Trial clamping of the gastroduodenal artery (GDA) is essential to evaluate the need for revascularization in these patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Vascular Surgery
Background:
- Pancreatoduodenectomy necessitates sacrificing the gastroduodenal artery (GDA), risking ischemia in vital organs.
- Celiac trunk occlusion presents a unique challenge during this procedure.
- The liver, stomach, pancreas, and anastomoses are vulnerable to ischemia.
Purpose of the Study:
- To investigate the implications of celiac trunk occlusion in patients undergoing pancreatoduodenectomy.
- To assess the safety and necessity of preserving GDA blood flow in such cases.
Main Methods:
- A global survey of 17 specialized surgical centers identified 15 patients with celiac trunk obstruction.
- Data on patient demographics, occlusion causes, surgical interventions, and outcomes were collected.
- Trial clamping of the GDA was performed in 11 patients to assess ischemic risk.
Main Results:
- Occlusion causes included atheromatous disease (13) and arcuate ligament compression (2).
- Trial GDA clamping revealed significant ischemia in 4 patients.
- Vascular interventions such as ligament division, GDA preservation, aorto-hepatic bypass, and celiac trunk reimplantation were performed in 6 patients.
- Complications occurred in 5 patients, with 2 fatalities.
Conclusions:
- Celiac trunk occlusion typically poses minimal risk during pancreatoduodenectomy.
- Trial GDA clamping is a critical step to determine the need for revascularization procedures.
- Careful assessment and potential vascular intervention can mitigate risks associated with GDA sacrifice in these patients.
Background:
Performance of pancreatoduodenectomy involves sacrifice of the gastroduodenal artery (GDA), which poses an ischemic threat to the liver, stomach, pancreas, and various anastomoses in patients with celiac trunk occlusion.
Methods:
A survey was conducted in surgical centers with expertise in the field of pancreatic surgery. Detailed information was collected from 17 institutions worldwide. Fifteen patients with celiac trunk obstruction were identified. The indication for resection was periampullary tumor in 10 cases and chronic pancreatitis in 5.
Results:
The cause of occlusion was atheromatous disease in 13 cases and arcuate ligament in 2. Trial clamping of the GDA was done in 11 patients, and provoked obvious ischemia in 4. Six patients underwent vascular procedures: the arcuate ligament was severed in 2 cases, the GDA was preserved in 2 cases of chronic pancreatitis, an aorto-hepatic bypass was performed in 1 case, and the celiac trunk was reimplanted in 1 case. Complications occurred in 5 patients, with 2 fatalities.
Conclusions:
Occlusion of the celiac trunk in patients undergoing pancreatoduodenectomy rarely leads to significant problems. Trial clamping of the GDA is required to assess the need for revascularization.