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Review
. 2022 Aug 31;26(3):229-234.
doi: 10.14701/ahbps.22-013. Epub 2022 Aug 8.

Do jejunal veins matter during pancreaticoduodenectomy?

Mee Joo Kang  1 , Sung-Sik Han  1 , Sang-Jae Park  1 , Hyeong Min Park  1 , Sun-Whe Kim  1
Affiliations
Review

Do jejunal veins matter during pancreaticoduodenectomy?

Mee Joo Kang et al. Ann Hepatobiliary Pancreat Surg. .

Abstract

When planning pancreaticoduodenectomy for pancreatic head cancer, the prevalence of anatomical variation of the proximal jejunal vein (PJV), the associated short-term surgical outcomes, and the level of PJV convergence to the superior mesenteric vein must be carefully analyzed from both technical and oncological points of view. The prevalence of the first jejunal trunk (FJT) and PJV located ventral to the superior mesenteric artery is 58%-88% and 13%-37%, respectively. Patients with the FJT had a larger amount of intraoperative bleeding and a higher proportion of patients requiring transfusions compared to those without a common trunk. The risk of transfusion was higher in patients with ventral PJV compared to those with dorsal PJV. Although less frequent, sacrificing the FJT can result in fatal venous congestion of the jejunum. Therefore, a well-planned approach for pancreaticoduodenectomy, based on preoperative evaluation of anatomical variation in the PJV, may help reduce intraoperative bleeding and postoperative morbidity. Additionally, the importance of invasion into the PJVs should be revisited in terms of resectability and oncological clearance.

Keywords: Anatomy; Hemorrhage; Pancreaticoduodenectomy; Prognosis; Veins.

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Conflict of interest statement

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Computed tomography images of the proximal jejunal vein anatomy. (A) First jejunal trunk (FJT) located dorsal to the superior mesenteric artery (SMA) (type 1). (B) FJT located ventral to the SMA (type 2). (C) First jejunal vein (J1V) located dorsal to the SMA (type 3). (D) J1V located ventral to the SMA (type 4). The arrows indicate proximal jejunal veins with each type of anatomical variation.
Fig. 2
Fig. 2
An illustration of the relationship between proximal jejunal vein (PJV) and pancreatic head cancer. (A) PJV located dorsal to the SMA. Dorsal PJV can get injured during identification of the inferior pancreaticoduodenal artery, which is embedded in the dorsal side of the mesoduodenum. (B) PJV located ventral to the SMA. Dissecting ventral PJV from the SMA may cause bleeding from the inferior pancreaticoduodenal veins, which are drained into the PJV. SMA, superior mesenteric artery; SMV, superior mesenteric vein.
See this image and copyright information in PMC

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