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General Surgery
Pancreas Surgery, Anatomic Complications
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
10 sections · 116 slides
Overview
- Scope of this topic
Exploration of the pancreas
- Routes of exposure of the pancreas
- Kocherization of the duodenum
- Palpation of the head and intrapancreatic bile duct
- Digital exploration behind the neck of the pancreas
- Separation of the neck from the SMV and portal vein
- Order of operative exploration
- The uncinate process as the difficult zone
- Evaluating resectability
- Resection without histologic proof
- Preoperative imaging and staging tests
- Local excision of periampullary lesions
- Ampulla and papilla: terminology
- Preoperative biliary drainage before pancreaticoduodenectomy
Pancreatic carcinoma
- Site distribution of pancreatic cancer
- Long-term survival after resection
- Actual versus actuarial survival after pancreatectomy
- Survival Data after Pancreatectomy for Pancreatic Cancer in Recent Publications (since 1990)
- Survival Data after Pancreatectomy for Pancreatic Cancer in Recent Publications (since 1990) (continued)
- Extent of lymph node dissection and palliative resection
- Selected indications for aggressive resection
- Solid and papillary epithelial neoplasm
- Palliation of unresectable carcinoma
- Tumour-specific 10-year actuarial survival
- Ampullary villous adenoma and ampullectomy
- Oncological resection of ampullary carcinoma
Pancreatic resection
- Extent of total pancreatectomy
- Structures preserved in total pancreatectomy
- Outcome of total pancreatectomy by underlying pathology
- Indications for total pancreatectomy
- Extent of the partial pancreatectomies
- The Whipple procedure
- Pylorus-preserving pancreaticoduodenectomy
- Oncological outcome of PPPD compared with the Whipple procedure
- Duodenum-preserving pancreatic head resection
- Two arterial territories of the pancreatic head
- Reconstruction of the pancreatic remnant
- Ninety-five percent pancreatectomy
- Pancreas, duodenum and bile duct as one unit
- Distal pancreatectomy
- Spleen preservation in distal pancreatectomy
- Distal pancreatectomy in chronic pancreatitis
- Tumour markers and cystic neoplasms
- Islet cell tumours and multiple endocrine neoplasia type 1
- Segmental pancreatectomy
- Total versus partial pancreatectomy
Drainage procedures
- Pancreaticojejunostomy: the Puestow procedure
- Side-to-side modification for a broad pancreas
- Selection of the pseudocyst drainage site
- Drainage of a pseudocyst into the duodenum
- Drainage of a pseudocyst into the stomach
- Drainage of a pseudocyst into the jejunum
- Endoscopic and percutaneous options for pseudocysts
- Endoscopic stenting for spontaneous pancreatic pseudocyst
- Laparoscopy in pancreatic disease
Complications of exploration and diagnosis
- Vascular injury during exploration
- Gastroduodenal artery clamping and celiac axis occlusion
- Organ injury and inadequate exploration
- Complications of Some Diagnostic Procedures
- Complications of Some Diagnostic Procedures (continued)
- Preoperative tissue diagnosis of a pancreatic mass
- Complications of endoscopic sphincterotomy
- Three types of sphincterotomy perforation
Complications of pancreatic resection
- Anomalous hepatic arteries in pancreatic resection
- Aberrant right and left hepatic arteries
- Middle colic and inferior pancreatoduodenal arteries
- Gastroduodenal artery and the veins of the pancreatic neck
- Portal vein and other vessels at risk
- Injury to the cisterna chyli
- Consequences of pancreatoenteric anastomotic leak
- Prevention and management of pancreatic anastomotic failure
- Anatomic Complications of Pancreatic Resection
- Anatomic Complications of Pancreatic Resection (continued)
- Anatomic Complications of Pancreatic Resection (continued)
- Inadequate resection
Complications of pancreatitis-related procedures
- Complications of the Puestow procedure
- Complications of Surgical Procedures
- Complications of Surgical Procedures (continued)
- Complications of Surgical Procedures (continued)
- Complications of Surgical Procedures (continued)
- Complications of Surgical Procedures (continued)
- Complications of Surgical Procedures (continued)
- Arterial erosion in pancreatitis
- Bleeding and necrosis in pancreatic inflammatory disease
- Colonic complications of pancreatic disease
- Other organs injured in pancreatic inflammation
Pancreatic transplantation and trauma
- Simultaneous pancreas-kidney transplantation
- Preparation of the donor pancreas
- Implantation with ureteroneocystostomy
- Routes of venous and exocrine drainage
- Retransplantation after graft loss
- Surgical Complications (Nonurologic) after Simultaneous Pancreas-Kidney Transplantation in 237 Recipients
- Surgical Complications (Nonurologic) after Simultaneous Pancreas-Kidney Transplantation in 237 Recipients (continued)
- Urologic Complications Related to Pancreas Transplant
- Pancreatic trauma
Takeaways
- Key anatomic principles
- Key clinical points
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- Sources cited in the text (8 of 8)
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
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