Abstract
BackgroundThe aims of the present study were to demonstrate the anatomical change of superior mesenteric vein (SMV) branches and to show how the Cattell Braasch maneuver facilitates a safer ligation of these venous branches during a pancreatoduodenectomy (PD).MethodsBetween January 2010 and December 2019, 97 patients with peripancreatic tumors underwent pancreatectomy. We retrospectively reviewed preoperative triple-phase enhanced computed tomography (CT) images and analyzed variations in SMV branches. Anatomical changes in SMV branches after the Cattell Braasch technique were observed using our operation video and illustrations.ResultsThe first jejunal vein (J1v) in 75% of patients ran posterior to the superior mesenteric artery (SMA), while the remainder (25%) ran anterior to it. The inferior pancreatoduodenal vein (IPDV) was preoperatively detected in 91% of patients. The IPDV drained into the J1v in 74% of patients and into the SMV in 37%. After the Cattell Braasch maneuver, the J1v which ran posterior to the SMA now was found to lie to the right anterolateral side the SMA and the visualization of both the J1v and the IPDV were much more clearly visualized.ConclusionsThe most frequent venous variation was the IPDV draining into the J1v posterior to the SMA. After the Cattell Braasch maneuver, the IPDV was now located to the right anterolateral anterior aspect of the SMA which facilitates its visualization and should allow a safer ligation.
Highlights
The aims of the present study were to demonstrate the anatomical change of superior mesenteric vein (SMV) branches and to show how the Cattell Braasch maneuver facilitates a safer ligation of these venous branches during a pancreatoduodenectomy (PD)
Among the First jejunal vein (J1v) running posterior to the superior mesenteric artery (SMA), 70% (50/71) drained into the caudal side of a confluence of the gastro-colic trunk (GCT), while 88% (21/24) running anterior to the SMA drained into the cranial side of the confluence
The majority of inferior pancreatoduodenal vein (IPDV) directly draining into the SMV (83%) fed into the posterior aspect of the SMV
Summary
The aims of the present study were to demonstrate the anatomical change of superior mesenteric vein (SMV) branches and to show how the Cattell Braasch maneuver facilitates a safer ligation of these venous branches during a pancreatoduodenectomy (PD). The Cattell Braasch maneuver has been applied to PD for the safe and complete resection of the mesopancreas [16, 17] This artery-first approach mobilizes the right colon and small intestine, thereby maximizing the visualization of the venous branches and their common anomalies as they drain into the SMV and in their anatomic relationship to the SMA [16]. We consider this method to be useful for avoiding injury to the small branches of the SMV by allowing better visualization of these venous branches
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