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CHAPTER 21 • Pancreaticoduodenectomy

Pancreas

Splenic vein

Portal vein

Portal vein Splenic vein SMV

Pancreas

SMV

Head of pancreas Vessel sealer

A

B

Stomach

Pylorus

Duodenum C

FIGURE 21.7 Removal of Pancreaticoduodenectomy specimen. The neck of the pancreas is divided above the SMV and portal vein (A). The lateral tributaries of the SMV and portal vein to the head and uncinate portions of the pancreas are divided (B). The stomach and the jejunum are both divided (C). Shown in (C) is a pylorus sparing pancreatectomy. (Ross SB, Downs DJ, Sucandy I, et al. Robotic pylorus-preserving pancreaticoduodenectomy. In: Fong Y, Woo Y, Hyung WJ, et al, eds. The SAGES Atlas of Robotic Surgery . Springer; 2018:319-334.)

Pancreatic duct Jejunum Pancreas

A

B

Stent in jejunostomy Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

Jejunum

C

D

FIGURE 21.8 Construction of pancreaticojejunostomy. An end-to-side pancreaticojejunostomy is preferred (A). The jejunum is opened (B). The anastomosis can be created over a plastic stent (C). The full reconstruction is shown in D.