Early retropancreatic lamina dissection during pancreaticoduodenectomy: how, when and why?

UNLABELLED Pancreaticoduodenectomy is the procedure of choice for tumors of the pancreatic head and periampullary region. During pancreaticoduodenectomy, early neck division may be inadequate in case of hepatic artery anatomic variants, suspected involvement of the superior mesenteric vessels or intraductal papillary mucinous neoplasms. MATERIAL AND METHODS We describe our early approach to the superior mesenteric vessels during pancreaticoduodenectomy, by retroportal lamina dissection before pancreatic transection. RESULTS We used this approach in 41 patients. There were 28 patients with abnormal hepatic artery, which was spared in 26 cases. Hepatic artery reconstruction was required in 2 cases. Nine patients with intraductal papillary mucinous neoplasms underwent 6 pancreaticoduodenectomies extented to the body and 3 total pancreaticoduodenectomies. Four patients with adenocarcinoma involving the portomesenteric vein required pancreaticoduodenectomy with venous resection and reconstruction. CONCLUSIONS Early retropancreatic lamina dissection is useful way to tailor a pancreaticoduodenectomy which is recommended in selective indications.