Pancreas Transplantation: a retroperitoneal graft placement

Abstract

Background: Techniques such as retroperitoneal graft placement have further improved the ability to reproduce the physiology of the “normal” pancreas.We herein present a video with the pancreas placed into a fully retroperitoneal position with systemic venous and enteric drainage of the graft by duodeno-duodenostomy. Methods: Back-table preparation was performed prior to transplantation.The donor duodenum was reduced to a length of 8–12 cm.The arterial reconstruction of the graft was created by anastomosis end-to-end between the splenic artery and distal superior mesenteric artery. Results: In the recipient,a median laparotomy was done for surgical access.The right colon was then mobilized and a Kocher manoeuvre was performed to expose the retroperitoneal site along with the vena cava and iliac vessels.The venous anastomosis was performed end-to-side between donor portal vein and recipient vena cava.The arterial supply for the graft was provided by anastomosis end-to-side between the graft superior mesenteric artery with the recipient common right-iliac artery. For enteric drainage a duodeno-duodenostomy was performed side-to-side by means of a hand-sewn, double-layered anastomosis, at the level between the second and third portions of the recipient’s duodenum. A drain was inserted beside the pancreas graft, ending near the duodeno-duodenostomy. Finally, the colon was returned to its original position Conclusion: The retroperitoneal placement of the pancreatic graft imitates the physiological position of the organ.