Celiac axis stenosis in pancreaticoduodenectomy

Background/Purpose. Celiac axis (CA) stenosis is a fairly common condition in candidates for upper abdominal surgery. In this report, we have documented 5 patients with CA stenosis or occlusion who underwent pancreaticoduodenectomy, and we have discussed the surgical strategy for this condition. Methods. We reviewed the records of 126 patients who had undergone resection of the pancreatic head during the past 10 years, and a search was made for obstructive lesions of the CA. Results. Among these 126 patients, there were 5 cases (4%) of CA stenosis or occlusion. Three of them were interpreted as typical CA compression syndrome, based on arteriographic or operative findings, and an excision of the median arcuate ligament dramatically improved the blood flow of the celiac branches after division of the main collaterals. The remaining 2 patients, with organized occlusion of the CA, successfully underwent pancreaticoduodenectomy through preservation of the collateral pathway between the superior mesenteric artery and the celiac branch. In one of these 2 patients, the main collateral pathway, which ran across immediately behind the pancreatic head, was skeletonized and preserved. All 5 patients had uneventful postoperative courses. Conclusions. We conclude that, in pancreaticoduodenectomy for patients with organized CA occlusion, precise assessment of the vascular anatomy and preservation of the main collateral pathway are essential for carrying out a successful operation.