Experience of Pylorus Preserving Pancreatoduodenectomy, after Coronary Artery Bypass Operations Using Right Gastroepiploic Artery; A Case Report

Satoshi Kaji, Nobuhiko Harada, Nobusada Koike, Syuji Suzuki, Mamoru Suzuki and Fujio Hanyu

Department of Surgery, Hachioji Digestive Disease Hospital

Ischemic heart disorders are often treated by coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA), but epigastric manipulation requires care to avoid RGEA injury. We report the case of a 72-year-old man with a history of CABG using RGEA who underwent pylorus-preserving pancreatoduodenectomy (PPPD) for invasive pancreatic cancer while preserving the RGEA. The man had been diagnosed with a pancreatic tumor when seen for anemia. Computed tomography (CT) showed the RGEA to be going to mediastinum at the left side of a hepatic falciform ligament, confirmed during surgery. The gastroduodenal artery (GDA) and the root of the RGEA had not invaded by cancer. After confirming the condition of the GDA, RGEA, and anterior superior pancreatoduodenal artery (ASPD), we dissected only the ASPD root. The histopathological finding was invasive ductal carcinoma and moderately to poorly differentiated adenocarcinoma.

Key words
coronary artery bypass grafting, right gastroepiploic artery, pylorus preserving pancreatoduodenectomy

Reprint requests
Satoshi Kaji Department of Surgery, Hachioji Digestive Disease Hospital
177-3 Yorozu-cho, Hachioji, 192-0903 JAPAN

Accepted
November 18, 2009

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