Complications - Pylorus-preserving pancreaticoduodenectomy, according to Longmire-Traverso, robotically assisted

  1. Prophylaxis and management of intraoperative complications

    Vascular Injuries

    • V. portae/V. mesenterica superior: Suturing, partial resection, and end-to-end anastomosis
    • A. hepatica communis, dextra, sinistra → Patch, partial resection, and end-to-end anastomosis
    • V. cava: very rare, suturing
    • Vascular injury in the transverse mesocolon with perfusion disorder of the transverse colon: very rare > Resection of the ischemic bowel segment and end-to-end anastomosis

    Injury to Adjacent Organs

    • Stomach: very rare deserosation possible > Suturing
    • Intestine: rare deserosation possible > Suturing
    • Liver: rare bleeding or bile leak > Electrocoagulation, liver suturing

    Pancreatitis

    • Very fragile, soft pancreas or assistance error → Pressure damage from hooks

    Unrecognized Dunbar Syndrome

    • Compression syndrome of the celiac trunk by the medial arcuate ligament of the diaphragm → A. gastroduodenalis must not be transected! → Division of the arcuate ligament

    Coagulation Damage to the Common Hepatic Duct

    • Ischemic damage → later insufficiency, CAVE: Electrocoagulation
Prophylaxis and management of postoperative complications

Preliminary Remarks:The primary causes of postoperative morbidity and mortality following pancreati

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