The role of revascularization in celiac occlusion and pancreatoduodenectomy

Background: Performance of pancreatoduodenectomy involves sacrifice of the gastroduodenal artery (GDA), which poses an ischemic threat to the liver, stomach, pancreas, and various anastomoses in patients with celiac trunk occlusion. Methods: A survey was conducted in surgical centers with expertise in the field of pancreatic surgery. Detailed information was collected from 17 institutions worldwide. Fifteen patients with celiac trunk obstruction were identified. The indication for resection was periampullary tumor in 10 cases and chronic pancreatitis in 5. Results: The cause of occlusion was atheromatous disease in 13 cases and arcuate ligament in 2. Trial clamping of the GDA was done in 11 patients, and provoked obvious ischemia in 4. Six patients underwent vascular procedures: the arcuate ligament was severed in 2 cases, the GDA was preserved in 2 cases of chronic pancreatitis, an aorto-hepatic bypass was performed in 1 case, and the celiac trunk was reimplanted in 1 case. Complications occurred in 5 patients, with 2 fatalities. Conclusions: Occlusion of the celiac trunk in patients undergoing pancreatoduodenectomy rarely leads to significant problems. Trial clamping of the GDA is required to assess the need for revascularization.