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Complications - Duodenohemipancreatectomy with Blumgart anastomosis and biliopancreatic separation

  1. Prophylaxis and Management of Intraoperative Complications

    Bleeding/Vascular Injuries

    • V. portae/V. mesenterica superior → Oversewing, partial resection, and end-to-end anastomosis
    • A. hepatica communis, dextra, sinistra → Patch, partial resection, and end-to-end anastomosis

    Injury to the Transverse Mesocolon with Perfusion Disorder of the Transverse Colon

    • very rare → Resection of the ischemic bowel segment and end-to-end anastomosis

    Pancreatitis

    • very fragile, soft pancreas or assistance error → Pressure damage due to hook

    Unrecognized Dunbar Syndrome

    • Compression syndrome of the celiac trunk by the medial arcuate ligament of the diaphragm → A. gastroduodenalis must not be severed! → Division of the arcuate ligament

    Coagulation Damage to the Common Hepatic Duct (ischemic damage → later insufficiency)

    • CAVE: Electrocoagulation

    Injury to Organs

    • Immediate oversewing
    • Liver: rare bleeding or bile leak → Electrocoagulation, liver suture
Prophylaxis and Management of Postoperative Complications

Anastomotic leakage and pancreatic fistula are the main causes of postoperative morbidity and morta

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