The Arterial Blood Supply of the Distal Duodenum in Relation to a New Method of Duodenum-preserving Total Pancreatic Head Resection

Hideki Ryo, Fujio Hanyu*, Takaho Watayo*, Toshihide Imaizumi*, Mitsuji Nakamura*, Yasushi Suzuki, Yasushi Shimizu, Toshio Arai*, Kunio Ido**, Kenji Ogawa**, Jun Koizumi**

Department of Surgery, Shiseikai Second Hospital
*Department of Gastroenterological Surgery, Tokyo Women's Medical College
**Department of Diagnostic Radiology, Keio University School of Medicine

To establish a procedure for duodenum-preserving total pancreatic head resection (DPTPID, we investigated vascular distribution patterns in the distal duodenum (DD). We performed superior mesenteric artery (SMA) angiography and selective inferior pancreaticoduodenal artery (IPD) angiography in 25 patients who had no pancreatic head disease. The DD was defined as that part of the duodenum extending from the right border of the superior mesenteric vein (SMV) to the nearest recurrent branch of the first jejunal artery (JI). The duodenal branches (D-branch) to the DD were divided into three groups by their origin: A) 11 from the IPD and JI. B) 6 from the anastomotic arcade (AA) between the IPD and JI. C) 8 from the IPD only. Variations of the IPD were classified by whether a common trunk (C.T) with the JI existed or not: I) 16 with a C.T. II) 9 without a C.T. On the assumption that DPTPH would be performed by resection along the SMA to remove the uncinate process, severe impairment of the blood supply to the DD could occur in following 6 (24% of all patients): an atypical Jl in 1 of group A, uneven D-branch origins in 1 of group B, and absence of a C.T in 4 of group C. Since DPTPH is chiefly used for benign lesions, a better approach for securing the blood to the DD may be resection along the right border of the SMV.

Key words
blood supply of the distal duodenum, duodenum-preserving total pancreatic head resection, duodenal branches to the distal duodenum, inferior pancreaticoduodenal artery, common trunk with the first jejunal artery

Reprint requests
Hideki Ryo Department of Surgery, Shiseikai Second Hospital
5-19-1 Kamisoshigaya, Setagaya, Tokyo, 157 JAPAN

Accepted
June 17, 1992

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