New surgical approaches to pancreas transplantation
https://doi.org/10.47619/2713-2617.zm.2020.v1i1;38-50
Abstract
Background. The main controversial technical issues of pancreas transplantation are kinds of diverting pancreatic secret from the transplanted organ, as well as methods of its arterial reconstruction to ensure adequate and full blood supply of the graft. The article describes our experience in introducing two new technical variants of pancreas transplantation into clinical practice: with stump-free duodenal drainage and with its isolated blood supply by the splenic artery. Materials and methods. Our proposed operation with stump-free duodenal drainage of pancreatic secret using the button-technique method allows to minimize complications caused by duodenal injury and to reduce the antigenic load. The hardware method of forming the intestinal anastomosis allows to create a uniform compression along the line of anastomosis, provides strength and tightness of the seam, accurate tissue comparison, and the ability to adjust the closure of the brackets contributes to reliable hemostasis of tissues of different thickness. Results. The modified technique of pancreas transplantation with isolated blood supply through the splenic artery can be used both when it is impossible to perform the generally accepted arterial reconstruction of the graft, and as a routine procedure, since adequate and sufficient hemoperfusion of all pancreatoduodenal graft’s parts with its isolated blood supply through the splenic artery is justified and possible due to the presence
of a developed system of collaterals between the splenic and superior mesenteric arteries.
About the Authors
A. V. Pinchuk
N.V. Sclifosovsky Research Institute of Emergency Medicine
Russian Federation
Russian Federation
Alexey V. Pinchuk − PhD, the head of kidney and pancreas transplantation science department
3, Bolshaya Sukharevskaya Sq., 129090, Moscow
Y. A. Anisimov
N.V. Sclifosovsky Research Institute of Emergency Medicine
Russian Federation
Russian Federation
Yuriy A. Anisimov − surgeon of kidney and pancreas transplantation department
3, Bolshaya Sukharevskaya Sq., 129090, Moscow
References
1. Leone JP, Christensen K. Postoperative Management. Chapter 9.2.2. Surgical complications. In: Gruessner RWG, Sutherland DER, editors. Transplantation of the pancreas. New York: Springer; 2004. р. 206–237.
2. Oberholzer J, Tzvetanov IG, Benedetti E. Surgical complications of pancreas transplantation. Chapter 11. In: Hakim NS, Stratta RJ, Gray D, Friend P, Coleman A, editors. Pancreas, islet, and stem cell transplantation for diabetes. 2nd ed., Oxford university press; 2010. р. 179–189.
3. Corry RJ, Shapiro R, editors. Pancreatic Transplantation, New York: Informa Healthcare; 2007. р. 159–170.
4. Srinivas TR, Shoskes DA, editors. Kidney and Pancreas Transplantation. A Practical Guide, New York: Humana press; 2011. 440 p.
5. Nghiem DD. Revascularization of the gastroepiploic artery in pancreas transplant. Transpl Int. 2008; 21(8):774-7. doi:10.1111/j.1432-2277.2008.00683.x
6. Troppmann C. Surgical complication. In: RWG Gruessner, DER Sutherland, eds. Transplantation of the pancreas. New York: Springer; 2004; 206−237.
7. Hakim NS, Stratta RJ, Gray D, Friend P, Coleman A, eds. Pancreas, islet, and stem cell transplantation for diabetes. 2nd ed. Oxford University Press; 2010. p. 179−189.
8. Badosa F, Baquero A, Cope C, Morris M, Bannett AD. Arterial supply to the pancreas: anatomic variations pertinent to whole organ transplantation. Transplant Proc. 1987;19(5):3937-8.
9. Ibukuro K. Vascular anatomy of the pancreas and clinical applications. Int J Gastrointest Cancer. 2001;30(1-2):87-104. doi:10.1385/IJGC:30:1-2:087
10. Moya-Herraiz A, Muñoz-Bellvis L, Ferrer-Fábrega J, Manrique Municio A, Pérez-Daga JA, Muñoz-Casares C, Alarcó-Hernández A, Gómez-Gutiérrez M, Casanova-Rituerto D, Sanchez-Bueno F, Jimenez-Romero C, Fernández-Cruz Pérez L. Cooperative Study of the Spanish Pancreas Transplant Group (GETP): Surgical Complications. Cir Esp. 2015;93(5):300-6. doi: 10.1016/j.ciresp.2014.12.006
11. DeRoover A, Detry O, Coimbra C, Squifflet JP, Honoré P, Meurisse M. Exocrine pancreas graft drainage in recipient duodenum through side-to-side duodeno-duodenostomy. Transplant Int. 2008;21(7):707. doi:10.1111/j.1432-2277.2008.00684.x
12. Hummel R, Langer M, Wolters HH, Senninger N, Brockmann JG. Exocrine drainage into the duodenum: a novel technique for pancreas transplantation. Transplant Int. 2008;21(2):178-81. doi:10.1111/j.1432-2277.2007.00591.x
13. Walter M, Jazra M, Kykalos S, Kuehn P, Michalski S, Klein T, Wunsch A, Viebahn R, Schenker P. 125 Cases of duodenoduodenostomy in pancreas transplantation: a single-centre experience of an alternative enteric drainage. Transplant Int. 2014;27(8):805-815. doi:10.1111/tri.12337
14. Boggi U, Vistoli F, Signori S, Del Chiaro M, Amorese G, Vanadia Bartolo T, Croce C, Sgambelluri F, Marchetti P, Mosca F. Outcome of 118 pancreas transplants with retroperitoneal portal-enteric drainage. Transplant Proc. 2005;37(6):2648-50. doi:10.1016/j.transproceed.2005.06.081
15. Spetzler VN, Goldaracena N, Marquez MA, Singh SK, Norgate A, Mc-Gilvray ID, Schiff J, Greig PD, Cattral MS, Selzner M. Duodenal leaks after pancreas transplantation with enteric drainage — characteristics and risk factors. Transplant Int. 2015;28(6):720-728. doi:10.1111/tri.12535
16. Adamec M, Janousek L, Saudek F, Tosenovsky P. 100 Pancreas transplantations with extraperitoneal graft placement. Ann Transplant. 2001;6(2):41-42.
17. Cattral MS, Bigam BL, Hemming AW, Carpentier A, Greig PD, Wright E, Cole E, Donat D, Lewis GF. Portal venous and enteric exocrine drainage versus systemic venous and bladder exocrine drainage of pancreas grafts. Clinical outcome of 40 consecutive transplant. Ann Surg. 2000;232(5):688-695. doi: 10.1097/00000658-200011000-00011
18. Steurer W, Malaise J, Mark W, Koenigsrainer A, Margreiter R. Spectrum of surgical complications after simultaneous pancreaskidney transplantation in a prospectively randomized study of two immunosuppressive protocols. Nephrol Dial Transplant. 2005;20(Suppl 2):ii54-ii62. doi:10.1093/ndt/gfh1083
19. Humar A, Kandaswamy R, Drangstveit MB, Parr E, Gruessner AG, Sutherland DE. Prolonged preservation increases surgical complications after pancreas transplants. Surgery. 2000;127(5):545-551. doi:10.1067/msy.2000.104742
20. Herrero-Martínez JM, Lumbreras C, Manrique A, San-Juan R, García-Reyne A, López-Medrano F, Lizasoain M, de Dios B, Andrés A, Jiménez C, Gutiérrez E, Moreno E, Aguado JM. Epidemiology, risk factors and impact on long-term pancreatic function of infection following pancreas-kidney transplantation. Clin Microbiol Infect. 2013;19(12):1132-9. doi:10.1111/1469-0691.12165
21. Rostambeigi N, Kudva YC, John S, Mailankody S, Pedersen RA, Dean PG, Prieto M, Cosio FG, Kremers WK, Walker RC, Abraham RS, Stegall MD. Epidemiology of infections requiring hospitalization during long-term follow-up of pancreas transplantation. Transplantation. 2010;89(9):1126-33. doi: 10.1097/TP.0b013e3181d54bb9
22. Perdiz LB, Furtado GH, Linhares MM, Gonzalez AM, Pestana JO, Medeiros EA. Incidence and risk factors for surgical site infection after simultaneous pancreas-kidney transplantation. J Hosp Infect. 2009;72(4):326-31. doi: 10.1016/j.jhin.2009.04.016
23. Fontana I, Bertocchi M, Diviacco P, De Negri A, Magoni Rossi A, Santori G, Dodi F, Gasloli G, Famiglietti F, Gelli M, Ferrante R, Nardi I, Africano A, Valente U. Infections after simultaneous pancreas and kidney transplantation: a single-center experience. Transplant Proc. 2009;41(4):1333-5. doi: 10.1016/j.transproceed.2009.03.085
24. Li JQ, He ZJ, Si ZZ, Hu W, Li YN, Qi HZ. Gastroduodenal arterial reconstruction of the pancreaticoduodenal allograft. Transplant Proc. 2011;43(10):3905-7. doi: 10.1016/j.transproceed.2011.10.043
25. Farghadani M, Momeni M, Hekmatnia A, Momeni F, Baradaran Mahdavi MM. Anatomical variation of celiac axis, superior mesenteric artery, and hepatic artery: Evaluation with multidetector computed tomography angiography. J Res Med Sci. 2016;21:129. doi:10.4103/1735-1995.196611
26. Rafailidis V, Papadopoulos G, Kouskouras K, Chryssogonidis I, Velnidou A, Kalogera-Fountzila A. Multiple variations of the coeliac axis, hepatic and renal vasculature as incidental findings illustrated by MDCTA. Surg Radiol Anat. 2016;38(6):741-5. doi:10.1007/s00276-015-1598-1
27. Yamaguchi H, Wakiguchi S, Murakami G, Hata F, Hirata K, Shimada K, Kitamura S. Blood supply to the duodenal papilla and the communicating artery between the anterior and posterior pancreaticoduodenal arterial arcades. J Hepatobiliary Pancreat Surg. 2001;8(3):238-44. doi: 10.1007/s005340170023
28. Socci C, Orsenigo E, Zuber V, Caldara R, Castoldi R, Parolini D, Secchi A, Staudacher C. Triple arterial reconstruction improves vascularization of whole pancreas for transplantation. Transplant Proc. 2006;38(4):1158-9. doi: 10.1016/j.transproceed.2006.02.020
29. Mercer DF, Rigley T, Stevens RB. Extended donor iliac arterial patch for vascular reconstruction during pancreas transplantation. Am J Transplant. 2004; 4(5):834-7. doi: 10.1111/j.16006143.2004.00422.x
30. Барански А. Г. Хирургическая техника эксплантации донорских органов: шаг за шагом. – М.: ГЭОТАР-Медиа, 2014. − 219 с.
31. Yang HC, Gifford RR, Dafoe DC, Neumyer MM, Thiele BL. Arterial reconstruction of the pancreatic allograft for transplantation. Am J Surg. 1991;162(3):262-4. doi:10.1016/00029610(91)90083-p
32. Fernández-Cruz L, Astudillo E, Sanfey H, Llovera JM, Saenz A, Lopez-Boado MA, Bagur C. Combined whole pancreas and liver retrieval comparison between Y-iliac graft and splenomesenteric anastomosis. Transpl Int. 1992;5(1):54-6. doi:10.1007/BF00337191
33. Нерестюк Я. И. КТ-перфузия при опухолях поджелудочной железы // Медицинская визуализация. 2015; 3: 57−67.
34. Нестеров Д. В, Розенгауз Е. В. Динамическая компьютерная томография у больных раком поджелудочной железы. Оценка перфузии в опухоли и в паренхиме железы вне ее // Медицинская визуализация. 2014; 2:68−74.
35. Tan Z, Miao Q, Li X, Ren K, Zhao Y, Zhao L, Li X, Liu Y, Chai R, Xu K.The primary study of lowdose pancreas perfusion by 640-slice helical CT: a whole-organ perfusion. Springerplus.2015; 4: 192. doi: 10.1186/s40064-015-0950-6
Review
For citations:
Pinchuk A.V., Anisimov Y.A. New surgical approaches to pancreas transplantation. City Healthcare. 2020;1(1):38-50. (In Russ.) https://doi.org/10.47619/2713-2617.zm.2020.v1i1;38-50
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