Technical Details of an Anterior Approach to the Superior Mesenteric Artery During Pancreaticoduodenectomy

Introduction Use of central vascular ligation during dissection around the superior mesenteric artery (SMA) in pancreaticoduodenectomy (PD) for periampullary malignancies has rarely been documented. Methods We developed the SMA hanging technique (SHT) to facilitate central vascular ligation during PD. Briefly, SMA dissection was initiated using the supracolic anterior approach, followed by left-sided dissection. The SMA was taped under finger guidance immediately after right-sided dissection. The ligament of Treitz was detached from the SMA during left-sided dissection, facilitating adequate lymph node dissection while preserving the nerve plexus around the SMA. Forty-seven consecutive patients who underwent PD for periampullary malignancies were divided into two groups: 23 underwent SHT and 24 underwent conventional dissection. Patients' clinical results were assessed to evaluate the feasibility and validity of SHT. Blood loss volume, operation duration, and the incidence of bleeding during SMA dissection were significantly lower in the SHT group than in the conventional group. The short-term and oncological results were similarly acceptable in both groups. SHT is a feasible and safe technique with acceptable short-term outcomes. We propose the use of this procedure to standardize en bloc dissection around the SMA.