Journal of Gastrointestinal Surgery

, Volume 15, Issue 4, pp 690–693 | Cite as

Antegrade En Bloc Distal Pancreatectomy with Plexus Hanging Maneuver

  • Toru IkegamiEmail author
  • Takashi Maeda
  • Eiji Oki
  • Hiroto Kayashima
  • Kippei Ohgaki
  • Yoshihisa Sakaguchi
  • Ken Shirabe
  • Yoshihiko Maehara
How I do it



Although antegrade en bloc distal pancreatectomy is appropriate for invasive distal pancreatic malignancies, this technique is not easy to perform because the end-point of deep vertical resections cannot be controlled. This report describes the usefulness of the application of hanging maneuver in performing the radical surgery.


A tape for guidance is passed in a space behind the bundles of the left celiac and mesenteric plexus, followed by sagittal resection of the distal pancreas exposing the root of the celiac artery and superior mesenteric artery. After dividing the pancreas down to the level of the roots of the celiac and superior arteries, the distal pancreas is dissected from the retroperitoneum in medial to lateral fashion.


This technique was applied in six patients with distal pancreas malignancies, without any positive cancer cells at the resected margin. The mean tumor size was 3.0 ± 0.9 cm. The mean duration of surgery and intraoperative blood loss were 258 ± 71 min and 226 ± 240 ml, respectively.


Antegrade en bloc distal pancreatectomy with plexus hanging maneuver is an appropriate technique for treating distal pancreatic malignancies.


Hanging maneuver Distal pancreatectomy Pancreas cancer Nerve plexus 



Antegrade en bloc distal pancreatectomy with plexus hanging maneuver


Celiac artery


Distal pancreatectomy


Nerve plexus


Radical antegrade modular pancreatosplenectomy


Superior mesenteric artery


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Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Toru Ikegami
    • 1
    • 2
    Email author
  • Takashi Maeda
    • 2
  • Eiji Oki
    • 2
  • Hiroto Kayashima
    • 1
  • Kippei Ohgaki
    • 2
  • Yoshihisa Sakaguchi
    • 2
  • Ken Shirabe
    • 1
  • Yoshihiko Maehara
    • 1
  1. 1.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Department of Digestive SurgeryNational Kyushu Cancer CenterFukuokaJapan

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