Evolution of surgical techniques of pancreas transplantation

Abstract

The use of whole versus segmental graft is the major evolution of surgical procedure after segmental pancreas transplantation by duct injection. In relation to duct management, the techniques currently performed are pancreaticoduodenal transplantation with bladder or enteric drainage. The bladder drainage procedure is safe and enables urinary monitoring of exocrine secretions, but it creates several urologic and metabolic problems. Consequently, enteric drainage of exocrine secretions is performed either with or without the use of a Roux-en-Y loop. This procedure is the most physiologic of all duct management techniques, but an increased risk of surgical complications and lack of access to pancreatic duct secretions as indicators of allograft rejection are reported. Although the vascular aspects of pancreas transplantation have remained relatively constant through the years, and the recipient iliac vessels have generally been used for both venous and arterial anastomoses, in the last years, portal venous drainage of pancreas allograft has been performed. This is considered more physiologic, and several studies show that portal drainage is equivalent to the systemic drainage of the graft in terms of patient and graft survival.