Complications - Cephalic pancreatoduodenectomy with Blumgart anastomosis and biliopancreatic separation (Merheim technique)

  1. Prevention and management of intraoperative complications

    Bleeding/vascular injuries

    • Portal vein/superior mesenteric vein  → oversew, partial resection and end-to-end anastomosis
    • Right, left common hepatic artery → patch, partial resection and end-to-end anastomosis

    Injury to the transverse mesocolon with impaired perfusion of the transverse colon: very rare → resection of the ischemic bowel segment and end-to-end-anastomosis

    Pancreatitis
    Very delicate, soft pancreas or mistake by the assistant → retractor pressure injury

    → Undiagnosed Dunbar syndrome! ((trunk compression syndrome caused by arcuate ligament)  → The gastroduodenal artery must not be transected! → divide arcuate ligament

    Coagulation damage to common hepatic duct (ischemic damage→ leads to later insufficiency)

    • →.CAUTION: Electrocautery

    Organ injury

    • → Oversew immediately
    • → Liver: rarely bleeding or biliary leakage → electrocauterize/suture liver
Prevention and management of intraoperative complications

Postoperative morbidity and mortality in pancreatic surgery is mainly attributable to sepsis and bl

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