Gastroduodenal Artery Reconstruction as Salvage Procedure for Pancreas Head Ischemia during Transplantation: A Case Report

Garcia-Roca, Raquel; Pombo, Emiliano Astudillo

doi:10.4236/ojots.2012.24007

Cited by 2 publications

(3 citation statements)

References 5 publications

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“…Apart from PD, GDA is also important in other pancreatic surgeries . Bleeding from GDA, ASPDA or one of its branches can be very severe and difficult to control in pancreatic necrosectomy for walled off pancreatic necrosis involving the head and neck of pancreas.…”

Section: Pancreatic Surgerymentioning

confidence: 99%

“…In this case, blood supply gets compromised as it remains fully dependent on DPA and splenic artery. If the blood flow from these vessels is not enough, GDA or RGEA have been reconstructed independently above the donor SMA to recipient's common iliac artery using an external iliac jump graft from donor GDA or RGEA to recipient's common iliac artery, thereby providing the blood supply to the transplanted organs .…”

Section: Pancreatic Surgerymentioning

confidence: 99%

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Gastroduodenal artery: single key for many locks

Desai

Pande

2019

J Hepato Biliary Pancreat

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Gastroduodenal artery (GDA) commonly arises from common hepatic artery, a branch of celiac axis. It holds a unique anatomical position that connects the foregut and midgut due to its intimate communications with foregut and midgut arterial supply. Its numerous anatomical variations have a significant impact on planning and performance of hepatopancreaticobiliary (HPB) surgery. Its close relation to the first part of duodenum, common bile duct and head of pancreas makes it susceptible for inadvertent bleeding during or after surgery, or due to various HPB pathologies. Also, a large number of vascular interventions rely on GDA and its branches. Careful preoperative planning is the key and a detailed knowledge and awareness of its variant anatomy is of paramount importance, be it liver resections, liver transplant, biliary and pancreatic resections and pancreatic transplant or transarterial procedures involving these arteries. GDA can also be a cause of gastrointestinal hemorrhage due to true or pseudoaneurysms and anatomy has significant implications on its management. The article provides a succinct review on relevance of GDA anatomy and variations and highlights that preoperative planning and intraoperative awareness of variations is the key to performance of safe HPB surgery and interventions.

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Section: Pancreatic Surgerymentioning

confidence: 99%

Section: Pancreatic Surgerymentioning

confidence: 99%

Gastroduodenal artery: single key for many locks

Desai

Pande

2019

J Hepato Biliary Pancreat

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“…Upon ligation, the duodenum and head of the pancreas become dependent upon the inferior pancreatoduodenal artery (IPDA) from the superior mesenteric artery, which becomes the main contributor of blood supply to the head of the pancreas and duodenum [9,10]. Therefore, some authors have suggested that hypoperfusion of the donor duodenum and head of the pancreas allograft may lead to perioperative complications of pancreas transplantation, including enteric or pancreatic leaks [8,[11][12][13]. However, this suggestion was not confirmed in a cohort-matched clinical trial.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study of the Effect of Gastroduodenal Artery Reconstruction on Duodenal Oxygenation and Enzyme Content After Pancreas Transplantation

Offerni,

Ai Li,

Rasmussen

et al. 2023

World j. surg.

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Background Whole pancreas transplantation provides durable glycemic control and can improve survival rate; however, it can carry an increased risk of surgical complications. One devastating complication is a duodenal leak at the site of enteroenteric anastomosis. The gastroduodenal artery (GDA) supplies blood to the donor duodenum and pancreas but is commonly ligated during procurement. Since we have not had expressive changes in pancreatic back table surgical techniques in the recent decades, we hypothesized whether back table GDA reconstruction, improving perfusion of the donor duodenum and head of the pancreas, could lead to fewer surgical complications in simultaneous pancreas-kidney (SPK) transplants. Material and Methods Between 2017 and 2021, we evaluated demographic information, postoperative complications, intraoperative donor duodenum, recipient bowel O2 tissue saturation, and patient morbidity through the Comprehensive Complication Index (CCI®). Results A total of 26 patients were included: 13 underwent GDA reconstruction (GDA-R), and 13 had GDA ligation (GDA-L). There were no pancreatic leaks in the GR group compared to 38% (5/13) in the GDA-L group (p = 0.03913). Intraoperative tissue oxygen saturation was higher in the GDA-R group than in the GDA-L (95.18 vs.76.88%, p < 0,001). We observed an increase in transfusion rate in GDA-R (p < 0.05), which did not result in a higher rate of exploration (p = 0.38). CCI® patient morbidity was also significantly lower in the GDA-R group (s < 0.05). Conclusions This study identified improved intraoperative duodenal tissue oxygen saturation in the GDA-R group with an associated reduction in pancreatic leaks and CCI® morbidity risk. A larger prospective multicenter study comparing the two methods is warranted.

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Gastroduodenal Artery Reconstruction as Salvage Procedure for Pancreas Head Ischemia during Transplantation: A Case Report

Cited by 2 publications

References 5 publications

Gastroduodenal artery: single key for many locks

Gastroduodenal artery: single key for many locks

A Prospective Study of the Effect of Gastroduodenal Artery Reconstruction on Duodenal Oxygenation and Enzyme Content After Pancreas Transplantation

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