CHAPTER 105: Pancreas Transplant-Implantation

A midline incision is made and the abdominal contents explored to determine the absence of unexpected pathologies.

The transverse colon is retracted proximally, and the root of the small bowel mesentery is exposed.

The superior mesenteric vein, located ventral and to the right of the superior mesenteric artery, is dissected free of surrounding tissues.

The superior mesenteric vein (arrow) is exposed and readied for the anastomosis to the portal vein of the pancreas allograft.

The ascending colon and its mesentery are mobilized. An opening is made at an avascular site in the ascending colon mesentery to allow for the passage of the arterial graft.

Once the opening is made (yellow arrow), the surgeon may opt (as in this case) to thread a plastic loop through it for future identification. Note the superior mesenteric vein (blue arrow).

The aorta is dissected in its infrarenal portion for its future anastomosis to the arterial graft.

View of the abdomen demonstrating the superior mesenteric vein (blue arrow), the aorta (green arrow), and the opening in the ascending mesocolon (yellow arrow) that has been enlarged and held in place with a retractor. At this point, the abdomen is ready for the implantation of the pancreas graft.

The superior mesenteric vein is clamped proximally.

Once the clamp is applied, the vein is opened longitudinally and corner stitches placed.

The allograft is brought into the field, sometimes wrapped in a sponge with slush or fine ice. Everting corner stitches are placed in the donor portal vein, making sure that its orientation is consistent with that of the superior mesenteric vein of the recipient.

The venous anastomosis is started, using the corner stitches as guides.