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Pancreatic duct anatomy in the corpus area: implications for closure and anastomotic technique in pancreas surgery

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Abstract

Purpose

Pancreatic anastomosis and stump closure after partial pancreatectomy is the most critical step in pancreas surgery due to a high percentage of postoperative fistulas. Whether transverse cut side branches or the main pancreatic duct presents the source of this leak is still unknown. Thus, better understanding of the anatomy of the pancreatic duct system in the resection area could significantly improve the surgical technique and reduce complications.

Methods

We investigated the anatomy of the pancreatic duct in 25 human cadaveric pancreata with focus on the corpus area. Contrast agent was instilled into the pancreatic duct, and computed tomography was used to visualize the duct system in detail.

Results

In addition to the main and accessory pancreatic duct in the head, an additional accessory duct was observed within the pancreas corpus in 16% of the cases. Within the plane of the portal vein, fewer transversely cut side branches were observed as compared to the resection planes 2–4 cm beneath. The number of side branches was independent of the presence of pancreatic fibrosis.

Conclusions

From anatomical point of view, the resection level at the porto-mesenteric axis appears to be ideal. However, the presence of an accessory main duct has to be taken into account for sufficient surgical supply.

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Acknowledgment

We would like to thank Manuela Schneider and Horst Bergauer for excellent technical assistance.

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Author notes

  1. Peter Range

    Present address: Department of Radiology, Leopoldina Krankenhaus, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany

  2. Stephan Timm

    Present address: Department of Surgery, University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

Authors and Affiliations

  1. Department of Surgery I, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany

    Ulrich Steger, Stephan Timm & Nicolas Schlegel

  2. Department of Radiology, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany

    Peter Range & Florian Mayer

  3. Institute of Anatomy and Cell Biology, University of Wuerzburg, Koellikerstr. 6, 97070, Wuerzburg, Germany

    Jens Waschke & Nicolas Schlegel

Authors
  1. Ulrich Steger
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  2. Peter Range
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  3. Florian Mayer
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  4. Jens Waschke
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  5. Stephan Timm
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  6. Nicolas Schlegel
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Corresponding author

Correspondence to Ulrich Steger.

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Steger, U., Range, P., Mayer, F. et al. Pancreatic duct anatomy in the corpus area: implications for closure and anastomotic technique in pancreas surgery. Langenbecks Arch Surg 395, 201–206 (2010). https://doi.org/10.1007/s00423-009-0526-4

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  • DOI: https://doi.org/10.1007/s00423-009-0526-4

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