Specific Complications after Pancreatoduodenal Resection Depending on the Pancreatic Transection Plane and the Dorsal Pancreatic Artery Origin

Introduction. Pancreaticoduodenectomy (the Whipple procedure) is one of the most complex surgical interventions in abdominal surgery and is associated with a high risk of severe postoperative complications. Studying all aspects of the operation can reduce the incidence of adverse outcomes. One of the ways to reduce the incidence of postoperative complications after pancreaticoduodenectomy is to shift the pancreatic transection line to the left in order to remove the poorly blood-supplied zone between the cephalocervical and corporocaudal segments.

The aim of the study was to evaluate the effect of different pancreatic transection planes on the incidence of pancreatic fistula in various anatomical origins of the dorsal pancreatic artery.

Material and Methods. The study included 103 patients with the determined origin of the dorsal pancreatic artery. All patients were divided into two groups: with a standard origin of the dorsal pancreatic artery (69 patients) and with a variant origin of the dorsal pancreatic artery (34 patients). In each group, two subgroups were identified depending on the transection plane of the pancreas (at the midpoint of the portal vein and 10-15 mm to the left of its left edge). The short-tern treatment outcomes in subgroups were compared based on the arterial anatomy and transection plane.

Results. In cases of a standard origin of the dorsal pancreatic artery, relocation of the transection plane to the left led to a statistically significant reduction in the frequency of specific complications (p=0.04), clinically significant pancreatic fistula (p=0.037), and gastrostasis type B (ISGPS) (p=0.038). In cases of a variant origin of the dorsal pancreatic artery, no statistically significant difference in subgroups with different transection planes was found.

Conclusion. In case of a standard origin of the dorsal pancreatic artery, it is advisable to shift the transection line to the left. The algorithm for transecting the pancreas in other variants of the dorsal pancreatic artery origin requires further study.