A novel technique for pancreatic juice drainage to the remaining graft duodenum after blood reperfusion in pancreas transplantation.

In pancreatic transplantation, during bench surgery, the oral and anal sides of a graft duodenum are cut with linear staplers to be as short as possible in order to ascertain blood flow to the graft duodenum stumps. However, this can lead to a distended graft duodenum owing to the large amount of pancreatic juice produced after blood reperfusion during the recipient operation. Controlling bleeding after blood reperfusion and ensuring complete hemostasis are difficult due to obstructed vision caused by the distended graft duodenum. Additionally, the edematous mucosa due to the distended graft duodenum makes it difficult to anastomose the graft duodenum to the recipient's small intestine. Herein, we developed a novel technique during bench surgery to overcome these disadvantages of a distended graft duodenum, by initially leaving the anal side of the graft duodenum uncut to drain the produced pancreatic juice following blood reperfusion. After confirming the hemostasis and anastomosing the graft duodenum to the small intestine, the anal side of the graft duodenum is cut with a linear stapler at the point where sufficient blood flow is confirmed based on duodenal color. This technique enables us to concentrate on the hemostasis and anastomosis without attending to the distended graft duodenum. Furthermore, stump issues due to insufficient blood flow can be avoided. This pancreatic juice drainage technique in pancreas transplantation can be useful to reduce postoperative complications.

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