RT Book, Section A1 Miyara, Santiago J A1 Al-Salamy, Yasser A1 Guevara, Sara A1 Molmenti, Ernesto P A2 Molmenti, Ernesto Pompeo SR Print(0) ID 1194190510 T1 Pancreas Implantation T2 Molmenti’s Kidney and Pancreas Transplantation: Operative Techniques and Medical Management, 2e YR 2023 FD 2023 PB McGraw Hill PP New York, NY SN 9781260474275 LK accesssurgery.mhmedical.com/content.aspx?aid=1194190510 RD 2024/03/28 AB We meet with the patient immediately prior to the procedure to address any pending questionsIn instances of a combined kidney pancreas, we usually perform the pancreatic implantation prior to the renal one to minimize the pancreas cold ischemic time.In cases of systemic venous drainage (anastomosis to the external iliac vessels),the pancreas is preferably placed on the right lower quadrantallows drainage of exocrine contents into the small bowel or bladderplacing the pancreas on the right lower quadrant provides alignment of the iliac vessels and prevents topographic impediments (to the small bowel and bladder) associated with the left/sigmoid colon.The kidney is routinely placed on the left lower quadrant.This sidedness may be altered depending onSurgeon preferenceVascular disease involving the iliac vessels and aortaPrevious surgeries (transplants, ostomies, scars)Other factorsVerify that the correct allograft is available or will be available at the time of implantationThe recipient should have adequate venous access – at least two large bore peripheral IVPlacement of central venous lines depends on the potential for intra-operative decompensation as well as surgeon preferencePlacement of arterial lines depends on the potential for intra-operative decompensation as well as surgeon preferenceUrinary catheter ALWAYS placedWe routinely administer oral aspirin prior to and after the procedure.It is also our practice (if possible) NOT to discontinue medications that recipients may have been taking on a routine basisClopidrogel, oral anticoagulants, and other medications that predispose to hemorrhage can be either continued at the time of surgery or discontinued/reversed prior to the transplantThe risk of cardiovascular/thrombotic complications should be balanced with the possibility of bleeding when making this decision.If discontinued, they should be restarted postoperatively as soon as it is considered safe.IV fluids:Combined kidney pancreas transplantWe routinely administer 2-4 liters of isotonic crystalloids during the entire procedure.However, such volume can be modified based on physiologic parameters obtained during the surgeryAdding potassium to IV fluids is discouragedIsolated pancreas transplantThe volume of IV fluids administered is based on the physiologic needs of each individual patient.We routinely maintain sequential compression devices on both lower extremities during the entire case to diminish the incidence of deep venous thromboses.