Abstract:

It is usually difficult to expose superior mesenteric vein (SMV)/portal vein by conventional approach in patients with chronic pancreatitis. Multiple superior mesenteric artery (SMA) approach combined with inferior colon approach can ensure the safety of LPD in this case. In this case, the posterior approach of SMA (1/3 of proximal SMA is easy to be exposed) was used to detect whether the root of SMA was invaded by tumor, and the radical operation or arterial resection and reconstruction was first judged. Then combined with the anterior approach of SMA (2/3 of distal SMA is easy to be exposed) to disconnect the feeding artery of uncinate process, meanwhile the sufficient operation space was exposed for the subsequent naked or resection and reconstruction of superior mesenteric vein. SMV can be traced anterogradely from the foot to the head through the subcolonic approach, which can avoid the injury of SMV caused by forcibly separating the severe adhesion area of the pancreatic neck.

Key words: Pancreatitis, chronic, Pancreaticoduodenectomy, Laparoscopes, Mesenteric artery, superior