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01.12.2015 | Correspondence | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

The view from 10,000 procedures: technical tips and wisdom from master pancreatic surgeons to avoid hemorrhage during pancreaticoduodenectomy

Zeitschrift:
BMC Surgery > Ausgabe 1/2015
Autoren:
Chad G. Ball, Elijah Dixon, Charles M. Vollmer, Thomas J. Howard
Wichtige Hinweise
Components of this manuscript were presented at the Americas Hepato-Pancreato-Biliary Association annual conference in Miami, Florida.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

All authors participated equally in the conceptualization, construction, editing and finalizing of this manuscript, as well as the consensus building process. All authors read and approved the final manuscipt.

Abstract

Pancreaticoduodenectomy remains the exclusive technique for surgical resection of cancers located within both the pancreatic head and periampullary region. Amongst peri-procedural complications, hemorrhage is particularly problematic given that allogenic blood transfusions are known to increase the risk of infection, acute lung injury, cancer recurrence and overall 30-day morbidity and mortality rates. Because blood loss can be considered a modifiable factor that reflects surgical technique, rates of perioperative blood loss and transfusion have been advocated as robust quality indicators. We present a correspondence manuscript that outlines peri-procedural concepts detailing a successful pancreaticoduodenectomy with minimal hemorrhage. These tips were collated from master pancreatic surgeons throughout the globe who have performed over 10,000 cumulative pancreaticoduodenectomies. At risk scenarios for hemorrhage include dissections of the superior mesenteric – portal vein, gastroduodenal artery, and retroperitoneal soft tissue margin. General principles in limiting slow continuous hemorrhage that may accumulate into larger total case losses are also discussed. While many of the techniques and tips proposed by master pancreas surgeons are intuitive and straight forward, when taken as a collective they represent a significant contribution to improved outcomes associated with the pancreaticoduodenectomy over the past 100 years.
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