The alternative arterial source during pancreatoduodenectomy when patient with total replaced hepatic artery from superior mesenteric artery

Abstract

Introduction: During pancreatoduodenectomy(PD), the gastroduodenal artery (GDA) which lied on the groove between duodenum and pancreatic head should be sacrificed. However if the source of the hepatic artery(HA) was replaced from celiac axis(CA) to superior mesenteric artery(SMA), it always followed the GDA direction and need to be segmental resection with end to end anastomosis for clear surgical margin. Unfortunately the tension of the anastomosis site may be large and the location was just behind the P duct anastomosis.