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Surgical Anatomy of the Pancreas and the Periampullary Region

  • Keishi Sugimachi
  • Yuki Bekki
  • Tomohiro Iguchi
  • Masaru Morita
  • Yasushi Toh
  • Kenji Takenaka
Chapter

Abstract

Pancreaticoduodenectomy (Whipple operation) is still the only option to cure pancreatic adenocarcinoma, but pancreatic resection is complicated by several factors. The pancreas lies within the curve of the duodenum and extends transversely across the posterior wall to the spleen. The celiac trunk, superior mesenteric artery, and portal vein run entangled in the region because of embryological rotation of the gut. Understanding the stereological anatomy is difficult because the pancreatic head is fixed to the superior mesenteric artery by the plexus. This chapter discusses the surgical anatomy of the pancreas and possible vascular variations for performing pancreatic surgery.

Keywords

Surgical anatomy Pancreas Anomaly Artery 

Abbreviations

AIPDV

Anterior inferior pancreaticoduodenal vein

ASPDA

Anterior superior pancreaticoduodenal artery

ASPDV

Anterior superior pancreaticoduodenal vein

GDA

Gastroduodenal artery

IPDA

Inferior pancreaticoduodenal artery

PIPDA

Posterior inferior pancreaticoduodenal artery

PLphI

Pancreatic head plexus I

PLphII

Pancreatic head plexus II

PSPDA

Posterior superior pancreaticoduodenal artery

PSPDV

Posterior superior pancreaticoduodenal vein

SMA

Superior mesenteric artery

SMA

Superior mesenteric vein

Notes

Acknowledgment

The authors thank Mr. Shinya Fukamachi for medical illustrations.

References

  1. 1.
    Jennings RE, Berry AA, Strutt JP, Gerrard DT, Hanley NA. Human pancreas development. Development. 2015;142(18):3126–37.CrossRefPubMedGoogle Scholar
  2. 2.
    Surgical KW. anatomy of the pancreas for limited resection. J Hepatobiliary Pancreat Surg. 2000;7(5):473–9.CrossRefGoogle Scholar
  3. 3.
    Kimura W, Nagai H. Study of surgical anatomy for duodenum-preserving resection of the head of the pancreas. Ann Surg. 1995;221(4):359–63.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Murakami G, Hirata K, Takamuro T, Mukaiya M, Hata F, Kitagawa S. Vascular anatomy of the pancreaticoduodenal region: A review. J Hepatobiliary Pancreat Surg. 1999;6(1):55–68.CrossRefPubMedGoogle Scholar
  5. 5.
    Ohigashi H, Ishikawa O, Eguchi H, Yamada T, Sasaki Y, Noura S, et al. Early ligation of the inferior pancreaticoduodenal artery to reduce blood loss during pancreaticoduodenectomy. Hepatogastroenterology. 2004;51(55):4–5.PubMedGoogle Scholar
  6. 6.
    Tempero MA, Malafa MP, Behrman SW, Benson AB 3rd, Casper ES, Chiorean EG, et al. Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2014;12(8):1083–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Kamisawa T, Ando H, Suyama M, Shimada M, Morine Y, Shimada H, et al. Japanese clinical practice guidelines for pancreaticobiliary maljunction. J Gastroenterol. 2012;47(7):731–59.CrossRefPubMedGoogle Scholar
  8. 8.
    Gockel I, Domeyer M, Wolloscheck T, Konerding MA, Junginger T. Resection of the mesopancreas (RMP): a new surgical classification of a known anatomical space. World J Surg Oncol. 2007;5:44.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Sharma D, Isaji S. Mesopancreas is a misnomer: time to correct the nomenclature. J Hepatobiliary Pancreat Sci. 2016;23(12):745–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Keishi Sugimachi
    • 1
    • 2
  • Yuki Bekki
    • 2
  • Tomohiro Iguchi
    • 1
  • Masaru Morita
    • 1
  • Yasushi Toh
    • 1
  • Kenji Takenaka
    • 2
  1. 1.Department of Hepatobiliary-Pancreatic SurgeryNational Kyushu Cancer CenterFukuokaJapan
  2. 2.Department of SurgeryFukuoka City HospitalFukuokaJapan

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