Surgical pitfalls of jejunal vein anatomy in pancreaticoduodenectomy

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 24; no. 7; pp. 394 - 400
• Main Authors: Ishikawa, Yoshiya, Ban, Daisuke, Matsumura, Satoshi, Mitsunori, Yusuke, Ochiai, Takanori, Kudo, Atsushi, Tanaka, Shinji, Tanabe, Minoru
• Format: Journal Article
• Language: English
• Published: Japan Wiley Subscription Services, Inc 01.07.2017
• Subjects: 3D‐CT; Adolescent; Adult; Aged; Aged, 80 and over; Digestive System Diseases - diagnostic imaging; Digestive System Diseases - surgery; Duodenum - blood supply; Duodenum - diagnostic imaging; Duodenum - surgery; Elevated jejunum; Female; Humans; Imaging, Three-Dimensional; Inferior pancreaticoduodenal vein; Jejunal vein; Jejunum - blood supply; Jejunum - diagnostic imaging; Jejunum - surgery; Male; Mesenteric Arteries - anatomy & histology; Mesenteric Arteries - diagnostic imaging; Mesenteric Veins - anatomy & histology; Mesenteric Veins - diagnostic imaging; Middle Aged; Multidetector Computed Tomography; Pancreas - blood supply; Pancreas - diagnostic imaging; Pancreas - surgery; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; Pancreaticoduodenectomy - methods; Veins & arteries; Young Adult; Inferior pancreaticoduodenal vein; 3D-CT; Pancreaticoduodenectomy; Jejunal vein; Elevated jejunum
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.451

Background Pancreaticoduodenectomy (PD) is the standard surgical procedure for treating pancreatic head cancers. Considerable knowledge of proximal jejunal and pancreatic vein anatomy is a prerequisite for performing PD surgery safely, yet there appear to be no detailed descriptions of first and second jejunal vein (J1V, J2V) anatomy available in the literature. Study design Adults with hepatobiliary‐pancreatic disease underwent multidetector‐row computed tomography with intravenous contrast (n = 155), and SYNAPSE 3D (Fujifilm Medical, Tokyo, Japan) was used to generate 3D‐CT images. Results In 84% of patients, J1V and J2V formed a common trunk (FJT). There were three patterns of branches, related to the presence or absence of FJT formation and the anatomical relationships between the superior mesenteric artery (SMA) and the jejunal veins, as follows: Type 1 (n = 98, 63%) characterized by an FJT located dorsal to SMA; Type 2 (n = 32, 21%), where the FJT was located ventral to the SMA; and Type 3 (n = 25, 16%), where J1V and J2V each drained separately into the SMV. Conclusions J1V and J2V usually formed an FJT, and separate J1V and J2V drainage into the SMV was uncommon. Preoperative information on individual patient venous anatomy would increase the safety of the PD procedure. Highlight Although considerable knowledge of proximal jejunal vein anatomy is required for performing pancreaticoduodenectomy safely, there have been no detailed descriptions of anatomical characteristics in different patients. Ishikawa and colleagues analyzed the anatomy of the proximal jejunal veins on 3D‐CT and clarified the patterns of the first and second jejunal veins.