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Intraabdominal Off-pump Rerouting Procedure Of Patent Gastroepiploic Arterial Grafts For Pancreaticoduodenectomy

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Intraabdominal off-pump rerouting procedure of patent gastroepiploic arterial grafts

for pancreaticoduodenectomy
Tomohiro Mizuno, Kenji Sakai, Daiju Watanabe, Eiki Nagaoka, Keiji Oi, Tsuyoshi Hachimaru, Minoru Tanabe, Hirokuni Arai
Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan

【Background】

Right gastroepiploic arterial (GEA) grafts have been utilized for severely stenotic right coronary arteries because the GEA can provide good patency after coronary artery bypass grafting (CABG).

However, there has been of great concern on subsequent laparotomy for abdominal diseases if the GEA graft is patent because of adhesions or the need to resect the GEA. Unfortunately, there have been little reports on the management of patent GEA in abdominal surgery.

【Patients and Methods】

From 1996 to 2016, GEA was used for CABG in 287 patients at our institution. Of the patients, 14 abdominal surgery were performed for abdominal diseases in 11 patients with a patent in-situ GEA for CABG.

We investigated the results of those abdominal operations and how to manage the GEAs in abdominal surgery.

【Results】

⊚ 14 abdominal surgeries were performed in 11 patients.

 

⊚ The adhesion of the grafted GEA was minimal except 

    for adhesion to the surface of the liver, and graft injury 

    or any difficulty to expose the GEA did not occur in all

    cases.

 

⊚ GEA could be preserved in 8 patients.

 

⊚ The GEA grafts had to be resected and reconstructed

    in 3 patients who underwent pancreoduodenectomy 

    (PD) for pancreatic ca. or cholangiocarcinoma.

 

⊚ Intra-abdominal off-pump rerouting of the GEA was 

    performed in those 3 patients.

  ・ Inflow: proximal GDA, primary hepatic A., left gastric A.

  ・ an intracoronary shunt tube was used to maintain

    the GEA flow

【Conlcusions】

Abdominal surgery for patients with patent GEA coronary grafts can be safely performed, and intra-abdominal rerouting of the GEA with a short saphenous vein is thought to be a good option if pancreaticoduodenectomy is necessary.

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