Resection of the Pancreatic Parenchyma

Resection of the overlying pancreatic tissue is required to facilitate decompression of the duct. Normally the duct in the body and tail is exposed first. A trough is created by resecting the overlying pancreatic tissue, with the pancreatic duct at the base. Enough pancreatic issue is left at the upper and lower borders of the pancreas to provide a margin to attach the Roux loop. Frequently, large pancreatic duct stones are encountered and are easily extracted.

To prepare for head coring, a series of 3-0 synthetic absorbable sutures is placed around the pancreatic head at the border of the duodenum to maintain hemostatic control during parenchymal resection. The incision in the pancreatic duct is carried into the head and all tissue anterior to the duct is excised in layers. Resection proceeds until approximately a thin, 1 cm margin of pancreas remains along posterior, lateral, superior, and inferior aspects. A biliary balloon catheter or sound is placed through the papilla into the duodenum to demonstrate unobstructed communication and to determine the right lateral resection margin (Fig. 37.5a-d). The surgeon must maintain awareness of the position of the portomesenteric veins and the posterior

Fig. 37.5 Parenchymal resection. (a) Stay sutures are placed around the head of the pancreas to maintain hemostasis during resection. (b) The parenchyma is excised in layers. (c) A pancreatic duct stone is encountered in the remnant pancreatic duct. (d) After resection is complete, open communication between the duct and the duodenum is demonstrated by inserting a Fogarty catheter through the ampulla

Surface of the pancreas, the latter by manual palpation of the mobilized duodenum. Excised tissue is sent for pathologic evaluation for occult pancreatic cancer.

  • Contact
  • Category: Surgical treatment