Pancreaticoduodenectomy in a soft pancreas

Aim.To evaluate the effects of different techniques of the pancreaticoduodenectomy (PD) on the frequency and severity of postoperative complications and mortality in patients with a "soft" pancreas. Material and methods.The results of 141 PDs were evaluated (76 were exposed the conventional surgery and 65 were exposed to the expanded volume of pancreatic resection, considering angioarchitectonics). In all cases, the pancreas was "soft", which was confirmed by morphological examination. The arterial architectonics of the cephalocervical segment of the pancreas was studied in the anatomical part of the study on 94 preparations, as well as clinical and radiological examination in 62 people. Results.In patients with "soft" pancreas, an increased volume of resection during PD, considering arterial architectonics in the cervical region, allowed for a slight improvement in the immediate results of the operation: the number of specific postoperative complications decreased from 51.3% to 43.1%, mortality decreased from 7.9% to 4.6%. The probability of a postoperative pancreatic fistula (POPF) increased in cases where the dorsal pancreatic artery was not a branch of the splenic artery. The formation of an anastomosis with a pancreatic stump on an isolated loop and the preservation of the gastrointestinal ligament at the stage of mobilization reduced the aggressiveness of postoperative complications. Conclusion.The expanded volume of pancreatic resection to ensure adequate blood supply of the stump of the organ appears to be an effective option only in cases of dorsal pancreatic artery withdrawal from the splenic artery. It is not possible to avoid ischemia of the pancreatic stump in other variants of the arterial anatomy of this vessel. In case of POPF, reconstruction involving two loops of the jejunum can reduce its aggressiveness. Mobilization of the complex with preservation of the gastrointestinal ligament facilitates the identification of the superior mesenteric vein and reduces the frequency of gastrostasis in the postoperative period.