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Pylorus-Preserving Pancreaticoduodenectomy for Pancreatic Cancer: How I Do It

  • Norbert Hüser
  • Volker Aßfalg
  • Matthias Maak
  • Helmut Friess
Chapter

Abstract

Pylorus-preserving partial pancreaticoduodenectomy is considered to be one of the most demanding and comprehensive operative procedures in visceral surgery and is usually performed for malignant lesions of the pancreatic head, the distal bile duct, or the duodenum. Numerous modalities of this procedure, which can be structurally divided into exploration, resection, and reconstruction, have been defined. The particularly determining relevance of postoperative pancreatic fistulas probably causes the outstanding key role of the pancreatic (duct) anastomosis during the procedure, which led to multitudinous clinical and experimental studies aiming for the best anastomotic technique. This chapter describes the procedure of the pylorus-preserving pancreaticoduodenectomy as performed at our center, illustrates the distinct operative phases with detailed pictures, and puts special emphasis on both the pancreatic and the biliodigestive anastomoses with clear drawings.

Abbreviations

BDA

Biliodigestive anastomosis

IPMN

Intraductal papillary mucinous neoplasm

PDS

Polydioxanone suture

PJ

Pancreaticojejunostomy

PPPD

Pylorus-preserving pancreaticoduodenectomy

SMA

Superior mesenteric artery

SMV

Superior mesenteric vein

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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Norbert Hüser
    • 1
  • Volker Aßfalg
    • 1
  • Matthias Maak
    • 2
  • Helmut Friess
    • 1
  1. 1.Department of SurgeryKlinikum rechts der Isar, Technische Universität MünchenMunichGermany
  2. 2.Department of SurgeryUniversitätsklinikum ErlangenErlangenGermany

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