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Back-table surgery pancreas allograft for transplantation: Implications in complications
To describe the main aspects of back-table surgery in pancreatic graft and the problems arising from poor technique. Back-table surgery for pancreatic graft is a complex, meticulous and laborious technique on which the success of implant surgery and perioperative results depends. The technique can b...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829682/ https://www.ncbi.nlm.nih.gov/pubmed/33552938 http://dx.doi.org/10.5500/wjt.v11.i1.1 |
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author | Briceño, Javier Sánchez-Hidalgo, Juan Manuel Arjona-Sanchez, Alvaro |
author_facet | Briceño, Javier Sánchez-Hidalgo, Juan Manuel Arjona-Sanchez, Alvaro |
author_sort | Briceño, Javier |
collection | PubMed |
description | To describe the main aspects of back-table surgery in pancreatic graft and the problems arising from poor technique. Back-table surgery for pancreatic graft is a complex, meticulous and laborious technique on which the success of implant surgery and perioperative results depends. The technique can be described in the following steps: Preparation of the sterile table, ex-situ inspection of the pancreas-spleen block, management of the duodenum, identification of the bile duct, preparation of the portal vein, preparation of the own graft arteries and anastomosis to the arterial graft, spleen management and graft preservation prior to implantation in the recipient. A careful inspection of the pancreas-spleen block should be performed. It is important to identify the stump of the main bile duct, the portal vein cuff, and the arrangement of the superior mesenteric artery and splenic artery. The redundant duodenum must be removed. The availability of a good venous cuff facilitates the portal vein anastomosis and the positioning of the graft, two key points to prevent thrombosis. The section line of the arteries must be clean, without atherosclerosis, to prevent arterial thrombosis. The superior and splenic mesenteric arteries are generally separated by dense fibrolymphatic tissue. The artery can be reconstructed by interposing a "Y" graft from the donor iliac artery; or with an end-to-end anastomosis between the splenic artery and the superior mesenteric artery. An exquisite technique of bench work helps to prevent the most feared complications of pancreas transplantation: Thrombosis and graft pancreatitis. |
format | Online Article Text |
id | pubmed-7829682 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-78296822021-02-04 Back-table surgery pancreas allograft for transplantation: Implications in complications Briceño, Javier Sánchez-Hidalgo, Juan Manuel Arjona-Sanchez, Alvaro World J Transplant Minireviews To describe the main aspects of back-table surgery in pancreatic graft and the problems arising from poor technique. Back-table surgery for pancreatic graft is a complex, meticulous and laborious technique on which the success of implant surgery and perioperative results depends. The technique can be described in the following steps: Preparation of the sterile table, ex-situ inspection of the pancreas-spleen block, management of the duodenum, identification of the bile duct, preparation of the portal vein, preparation of the own graft arteries and anastomosis to the arterial graft, spleen management and graft preservation prior to implantation in the recipient. A careful inspection of the pancreas-spleen block should be performed. It is important to identify the stump of the main bile duct, the portal vein cuff, and the arrangement of the superior mesenteric artery and splenic artery. The redundant duodenum must be removed. The availability of a good venous cuff facilitates the portal vein anastomosis and the positioning of the graft, two key points to prevent thrombosis. The section line of the arteries must be clean, without atherosclerosis, to prevent arterial thrombosis. The superior and splenic mesenteric arteries are generally separated by dense fibrolymphatic tissue. The artery can be reconstructed by interposing a "Y" graft from the donor iliac artery; or with an end-to-end anastomosis between the splenic artery and the superior mesenteric artery. An exquisite technique of bench work helps to prevent the most feared complications of pancreas transplantation: Thrombosis and graft pancreatitis. Baishideng Publishing Group Inc 2021-01-18 2021-01-18 /pmc/articles/PMC7829682/ /pubmed/33552938 http://dx.doi.org/10.5500/wjt.v11.i1.1 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Minireviews Briceño, Javier Sánchez-Hidalgo, Juan Manuel Arjona-Sanchez, Alvaro Back-table surgery pancreas allograft for transplantation: Implications in complications |
title | Back-table surgery pancreas allograft for transplantation: Implications in complications |
title_full | Back-table surgery pancreas allograft for transplantation: Implications in complications |
title_fullStr | Back-table surgery pancreas allograft for transplantation: Implications in complications |
title_full_unstemmed | Back-table surgery pancreas allograft for transplantation: Implications in complications |
title_short | Back-table surgery pancreas allograft for transplantation: Implications in complications |
title_sort | back-table surgery pancreas allograft for transplantation: implications in complications |
topic | Minireviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829682/ https://www.ncbi.nlm.nih.gov/pubmed/33552938 http://dx.doi.org/10.5500/wjt.v11.i1.1 |
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