Preliminary experience with the hanging maneuver for pancreaticoduodenectomy

Pessaux, Patrick; Rosso, Edoardo; Panaro, Fabrizio; Marzano, Ettore; Oussoultzoglou, Elíe; Bachellier, Philippe; Jaeck, Daniel

doi:10.1016/j.ejso.2009.04.009

Cited by 52 publications

(30 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pessaux et al proposed the "hanging maneuver" to achieve negative retroperitoneal margin [34]. Various other modifications like "posterior approach" and "artery first" were proposed because of the high propensity of positivity of the medial margin.…”

Section: Technical Modifications Proposed For Better Resection Of Mesmentioning

confidence: 99%

Mesopancreas in Pancreatic Cancer: Where do We Stand – Review of Literature

Ramachandra

Challa

2014

Indian J Surg Oncol

View full text Add to dashboard Cite

Pancreatic cancer is associated with poor prognosis and surgery remains the main modality of treatment. Negative resection margin is an important prognostic factor for survival. Retropancreatic margin or the medial margin is the most common site of positive resection margin. Mesopancreas was proposed in analogy with mesorectum, which is considered as a fusion fascia formed embryologically during the development of pancreas. This mesopancreas lies posterior to the pancreas and contains pancreaticoduodenal vessels, lymphatics, nerve plexus and loose areolar tissue. Various technical modifications were proposed for better dissection of mesopancreas like posterior approach and artery first approach. There is an increased rate of R0 resection by these technical modifications but whether this will turn to increase in survival rates is yet to be established.

show abstract

Section: Technical Modifications Proposed For Better Resection Of Mesmentioning

confidence: 99%

Mesopancreas in Pancreatic Cancer: Where do We Stand – Review of Literature

Ramachandra

Challa

2014

Indian J Surg Oncol

View full text Add to dashboard Cite

show abstract

“…It is considered a useful technique for tumors of the lower edge of the pancreas and facilitates retroperitoneal dissection, especially in locally advanced tumors receiving neoadjuvant therapy [9] . "Hanging maneuver" Pessaux et al [12] described an approach that combined the posterior and anterior technique, which they termed the "hanging maneuver". It has subsequently been used by other authors [11] .…”

Section: Posterior Approachmentioning

confidence: 99%

“…The objective of PD is a R0 resection, because free margins are relevant to prognosis [10] . However, up to 20% of PD have R1 resection; the most frequently invaded margin is the peripancreatic retroperitoneal margin [11] , representing 3-4 cm of tissue surrounding the origin of the SMA behind the SMV [12] . In 2003, Pessaux et al [13] presented a modification of the dissection of the retroportal pancreatic lamina which prioritized the dissection of the origin of the SMA, allowing complete lymphadenectomy, safe dissection of the SMA and accurate identification of anatomic variations such as a HA originating in the SMA.…”

mentioning

confidence: 99%

Tricks and tips in pancreatoduodenectomy

Pallisera

Morales

Ramia

2014

WJGO

View full text Add to dashboard Cite

Author contributions: Pallisera A wrote the introduction and the section on the artery-first approach; Ramia JM wrote the section on arterial complications during pancreatoduodenectomy; Morales R wrote the section on extended lymphadenectomy for pancreatic head adenocarcinoma. AbstractPancreaticoduodenectomy (PD) is the standard surgical treatment for tumors of the pancreatic head, proximal bile duct, duodenum and ampulla, and represents the only hope of cure in cases of malignancy. Since its initial description in 1935 by Whipple et al , this complex surgical technique has evolved and undergone several modifications. We review three key issues in PD: (1) the initial approach to the superior mesenteric artery, known as the artery-first approach; (2) arterial complications caused by anatomic variants of the hepatic artery or celiac artery stenosis; and (3) the extent of lymphadenectomy.

show abstract

“…This structure extends from the posterior surface of the pancreatic head to behind the mesenteric vessels. In order to excise this tissue en masse the recently described hanging technique is an elegant operative innovation [5]. Briefly, the duodenum is widely Kocherized beyond the medial border of aorta and the origin of superior mesenteric artery (SMA) is identified.…”

Section: Dear Sirmentioning

confidence: 99%

Extended pancreatectomy for pancreatic cancers

Sadhu

Roy

2010

Indian J Surg

View full text Add to dashboard Cite

Dear Sir,We read with interest the excellent article by Shukla et al.(Extended pancreatectomy for pancreatic cancers. IJS 2009; 71:2-5). It is a ready-reckoner for the surgeon who is keen to update on the contextual importance of extended pancreatic resection. That extended lymphadenectomy doesn't confer survival advantage, is well proven in randomised trials and meta-analysis [1]. But what constitutes a R0 (complete resection) is still mired in confusion mainly because of lack of unanimity amongst pathologist on a standardized technique of histopathological examination [2]. Achieving negative resection margin is not only a surgical triumph, but could potentially increase survival. A randomized study from a center of repute showed a trend towards increasing survival in pancreatic cancer patients who had extended resection and this was attributed mainly due to higher incidence of negative resection margin in this sub-group [3]. In this respect the retroperitoneal resection margin, often termed as mesopancreas, is finding increasing prominence in the recent literature [4]. This structure extends from the posterior surface of the pancreatic head to behind the mesenteric vessels. In order to excise this tissue en masse the recently described hanging technique is an elegant operative innovation [5]. Briefly, the duodenum is widely Kocherized beyond the medial border of aorta and the origin of superior mesenteric artery (SMA) is identified. A tunnel is dissected between the mesopancreas and the SMA and a tape is passed through. Sustained traction on this tape stretches the retroperitoneal margin, which is then excised in a controlled manner.To some extent, the traditional nihilism surrounding portal vein invasion by pancreatic malignancy has been partially annulled by finding survival equivalence between patients who were operable vis-vis those who required portal vein excision for complete clearance. However, this benefit is limited to patients with superficial invasion into the tunica adventitia [6]. With deeper portal vein wall invasion into the tunica media or intima, the survival is similar to those with non-curative surgery. The depth of portal vein invasion appears to correlate with preoperative CT portogram type C and D and a tumor diameter more than 45 mm [6].Although autologous venous and polytetrafluoroethylene grafts are conduits of choice for portal vein reconstruction, a generous Cattell-Braasch manoeuvre, wherein the ligament of Treitz is incised and hepatic flexure dissected liberally, serves to mobilise the root of mesentery and helps in moving it cranially. Mobilising the liver by incising the falciform, coronary and triangular ligaments causes a caudal displacement of the liver. These two steps in tandem approximate the transected ends of the portal vein and a defect as long as 5 cm could be primarily anastomosed in a tension free manner, thereby obviating the need for a graft [7].

show abstract

Preliminary experience with the hanging maneuver for pancreaticoduodenectomy

Abstract: Abstract:Background: Malignant periampullary tumours often invade retroperitoneal peripancreatic tissues and a

Cited by 52 publications

References 17 publications

Mesopancreas in Pancreatic Cancer: Where do We Stand – Review of Literature

Mesopancreas in Pancreatic Cancer: Where do We Stand – Review of Literature

Tricks and tips in pancreatoduodenectomy

Extended pancreatectomy for pancreatic cancers

Contact Info

Product

Resources

About