Total pancreatectomy

with splenectomy, duodenectomy, and reconstruction of the portal vein with superficial femoral vein graft to two branches of the superior mesenteric vein



02:19  Exposure

03:20  Mobilize pancreas head

05:26  Mobilize pancreas tail

06:27  Resection

08:56  1st PV-SMV branch reconstruction

10:38  2nd PV-SMV branch reconstruction

12:22  Bilioenteric reconstructions

Case description
  • A 66 year old man was diagnosed with chronic pancreatitis.
  • A total pancreatectomy with splenectomy and duodenectomy was proposed, with reconstruction of the portal vein to the largest branches of the SMV using a superficial femoral vein graft.
  • There was significant occlusion of the portal vein and superior mesenteric vein posterior to the pancreas, leading to development of collateral branches in and around the pancreas head.
  • The right gastric artery, gastroduodenal artery, splenic artery and arterial branches supplying the pancreas will be divided, but the celiac and main SMA will be preserved.
  • A replaced right hepatic artery was present, which supplied the pancreas head posteriorly, and will be preserved.
CTs (arterial phase)

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CTs (venous phase)

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