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World Journal of Surgery

, Volume 37, Issue 2, pp 430–436 | Cite as

Is Preservation of the Remnant Stomach Safe During Distal Pancreatectomy in Patients Who Have Undergone Distal Gastrectomy?

  • Hidenori TakahashiEmail author
  • Satoshi Nara
  • Hiroaki Ohigashi
  • Yoshihiro Sakamoto
  • Kunihto Gotoh
  • Minoru Esaki
  • Terumasa Yamada
  • Kazuaki Shimada
  • Masahiko Yano
  • Tomoo Kosuge
  • Osamu Ishikawa
Article

Abstract

Background

Whether the remnant stomach can be safely preserved when performing distal pancreatectomy (DP) in patients with a prior distal gastrectomy (DG) remains unclear because the remnant stomach and pancreatic body/tail share an arterial blood supply via the splenic artery (SPA).

Methods

A total of 18 patients with prior DG who underwent DP were enrolled in this study. Clinicopathologic data were retrospectively analyzed with a focus on management of the remnant stomach and complications related to ischemia of the remnant stomach. Additionally, intraoperative indocyanine green (ICG) fluorescence angiography was performed to visualize the blood flow and circulation in the remnant stomach.

Results

Ten patients underwent a standard DP (DP in conjunction with splenectomy and division of the SPA) with preservation of the remnant stomach. The entire stomach was preserved in seven patients, and three underwent concomitant partial resection of the remnant stomach. No patients in whom the entire remnant stomach was preserved developed postoperative complications associated with it, whereas two of the three patients who underwent partial resection of the remnant stomach developed severe ischemic complications. Intraoperative ICG fluorescence angiography revealed a caudally directed circulation of blood from the esophagogastric junction through the intramural capillary network in the remnant stomach.

Conclusions

When performing DP in patients with a prior DG, preservation of the entire remnant stomach was a safe procedure because of the presence of an intramural network that supplies blood to the remnant stomach. In contrast, partial resection of the remnant stomach could be dangerous because of the potential for severe ischemic complications.

Keywords

Distal Pancreatectomy Partial Resection Distal Gastrectomy Remnant Stomach Left Gastric Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

CCD

Charge-coupled device

DG

Distal gastrectomy

DP

Distal pancreatectomy

ICG

Indocyanine green

ISGPF

The International Study Group of Pancreatic Fistula

LED

Light-emitting diode

LGA

Left gastric artery

NCCH

National Cancer Center Hospital

OMCC

Osaka Medical Center for Cancer and Cardiovascular Diseases

PF

Pancreatic fistula

SPA

Splenic artery

Notes

Acknowledgments

This work was partly supported by a grant from the Otsuka Research Fund.

Conflict of interest

None of the authors has potential or real conflicts of interest associated with this study.

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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Hidenori Takahashi
    • 1
    Email author
  • Satoshi Nara
    • 2
  • Hiroaki Ohigashi
    • 1
  • Yoshihiro Sakamoto
    • 3
  • Kunihto Gotoh
    • 1
  • Minoru Esaki
    • 2
  • Terumasa Yamada
    • 1
  • Kazuaki Shimada
    • 2
  • Masahiko Yano
    • 1
  • Tomoo Kosuge
    • 2
  • Osamu Ishikawa
    • 1
  1. 1.Department of SurgeryOsaka Medical Center for Cancer and Cardiovascular DiseasesOsakaJapan
  2. 2.Hepatobiliary and Pancreactic Surgery DivisionNational Cancer Center HospitalTokyoJapan
  3. 3.Hepato-Biliary-Pancreatic Surgery Division, Department of SurgeryGraduate School of Medicine, University of TokyoTokyoJapan

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