Pancreatic duct anatomy in the corpus area: implications for closure and anastomotic technique in pancreas surgery

Abstract

Purpose: Pancreatic anastomosis and stump closure after partial pancreatectomy is the most critical step in pancreas surgery due to a high percentage of postoperative fistulas. Whether transverse cut side branches or the main pancreatic duct presents the source of this leak is still unknown. Thus, better understanding of the anatomy of the pancreatic duct system in the resection area could significantly improve the surgical technique and reduce complications.

Methods: We investigated the anatomy of the pancreatic duct in 25 human cadaveric pancreata with focus on the corpus area. Contrast agent was instilled into the pancreatic duct, and computed tomography was used to visualize the duct system in detail.

Results: In addition to the main and accessory pancreatic duct in the head, an additional accessory duct was observed within the pancreas corpus in 16% of the cases. Within the plane of the portal vein, fewer transversely cut side branches were observed as compared to the resection planes 2-4 cm beneath. The number of side branches was independent of the presence of pancreatic fibrosis.

Conclusions: From anatomical point of view, the resection level at the porto-mesenteric axis appears to be ideal. However, the presence of an accessory main duct has to be taken into account for sufficient surgical supply.