Extraperitoneal pancreatic transplant

Abstract

We describe a technique where pancreas transplants are positioned in the pre-peritoneal space with violation of only a few centimeters of the peritoneum necessary for the creation of the duodeno-enteric anastomosis. Retrieval and back-table of the pancreatic graft are performed in the standard fashion. After a Gibson incision is performed, the common and external iliac vessels are isolated and the head of the pancreas is laid in caudal position in the iliac fossa. The graft portal vein is anastomosed end-to-side to the recipient's common or external iliac vein. The arterial inflow is obtained anatomosing the “Y” iliac artery graft to the recipient's common or external iliac artery. After reperfusion, a 3–4 cm peritoneal incision in the medial aspect of the surgical field is performed and a loop of the recipient's small intestine is brought into the retroperitoneal space and anastomosed with a side to side or end to side to the free surface of the donor's duodenum without a Roux-en-Y intestinal loop. After completion of the duodeno-enteric anastomosis, the loop of intestine is repositioned in the peritoneal cavity and the suture line is approximated to the level of the recipient's peritoneal window. The advantages of this technique are several. Among them, the extra-peritoneal location of the pancreatic graft prevents formation of intestinal adhesions, facilitates percutaneous pancreatic graft biopsies and decreases the risk of diffuse peritonitis in patients who develop enteric leaks or peripancreatic infections.