| Background In PD, mesopancreas excision and suturing for cases with a non-dilated main pancreatic duct are technically difficult. We have devised new surgical techniques, including intestinal derotation procedure and pancreatic duct holder.Methods and results. [1] Intestinal derotation procedure: The entire small intestine and right colon are mobilized from the retroperitoneum, and intestinal rotation is reduced. This procedure simplifies the anatomic situation, in which the mesopancreas stretches from the right side of the superior mesenteric artery (SMA) in a horizontal plane, the IPDA arises from the right wall of the SMA, and the SMA is situated at the right-posterior side of the superior mesenteric vein. Perioperative factors were compared retrospectively between the derotation (n=117) and conventional (n=115) procedure groups. Intestinal derotation procedure significantly decreased operative time (434 vs 516 minutes), blood loss (521 vs 908 ml), and tended to increase the rate of R0 resection (90% vs 78%). [2] Pancreatic duct holder: This device has a cone-shaped tip with a slit. The holder can expand the pancreatic duct and provides a good surgical field for anastomosis. Perioperative outcomes between pancreatic duct holder (n=113) and conventional (n=113) procedure group yielded by propensity score matching was compared. Pancreatic duct holder significantly decreased the pancreatic fistula (5% vs 13%, ISGPF Grade B/C) and morbidity (12% vs 21%).Conclusion. Our procedures are simple and useful technique, for facilitating difficult procedures, and, improving perioperative outcomes. |
