Abstract
Background. Less extensive resection of the head of the pancreas has been the procedure of choice
recently for low-grade malignant neoplasms. The anatomical detail of the head of the
pancreas is currently insufficient for segmental resection along the embryological
fusion plane. Methods. The anatomy of the head of the pancreas was analyzed in 31 consecutive autopsy specimens.
An anterior (n = 10) or posterior (n = 10) segmentectomy of the head of each pancreas
was performed along the macroscopically found fusion plane. The pancreatic arteries,
the portal vein, the bile duct, and the pancreatic duct were visualized by injecting
3 silicon dyes of different colors. Another 11 specimens were examined by pancreatography
before and after anterior (n = 5) or posterior (n = 6) segmentectomy. Eight of these
11 specimens were stained immunohistochemically to reveal the distribution of pancreatic
polypeptide cells after segmentectomy. Results. The cleavage between the anterior and posterior segments was discovered at the anterior
inferior edge or at the posterior superior edge of the head of the pancreas. Anterior
segmentectomy was accomplished while preserving the anterior and posterior pancreaticoduodenal
arcades and the lower bile duct in the posterior segment. Posterior segmentectomy
involved the removal of the lower bile duct and the posterior pancreaticoduodenal
arcades. Pancreatography after segmentectomy showed the division of the ducts of Wirsung
and Santorini with the peripheral branches. The immunohistochemical boundary of pancreatic
polypeptide cells coincided with the surgical plane. These results showed the anterior
and posterior segments were originated from the embryologically dorsal and ventral
primordia, respectively. Conclusions. The current anterior or posterior segmentectomy of the head of the pancreas corresponded
to the resection of the embryologically dorsal or ventral primordium, respectively.
Anterior segmentectomy of the head of the pancreas might be a clinically applicable
procedure; however, posterior segmentectomy involving the resection of the lower bile
duct may be impractical. (Surgery 2000;128:822-31.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis.Surgery. 1985; 97: 467-473
- A new procedure duodenum-preserving total resection of the head of the pancreas with pancreatico- and choledochoduodenostomy [Japanese].J Bil Panc. 1990; 11: 621-626
- Duodenum-preserving pancreatoduodenostomy. A new technique for complete excision of the head of the pancreas with preservation of biliary and alimentary integrity.Hepatogastroenterology. 1993; 40: 356-359
- Ventral pancreatectomy: resection of the ventral segment of the pancreas.J Hepatobiliary Pancreat Surg. 1993; 1: 36-40
- Ventral pancreatic resection for adenoma and low-grade malignancies of the head of the pancreas.Surg Today. 1996; 26: 476-481
- Clinical aspects for the resection of the uncinate process of the pancreas (in Japanese).J Bil Panc. 1991; 12: 1369-1373
- Further evaluation of the resection of pancreatic uncus.[Japanese.] Geka. 1998; 60: 1158-1161
- Superior segmentectomy of the pancreas head [Japanese].J Bil Panc. 1994; 15: 1233-1236
- Resection of the inferior head of the pancreas: report of a case.Surg Today. 1996; 26: 640-644
- Surgical experience with pancreatic islet-cell tumors.Arch Surg. 1993; 128: 1143-1148
- Cystadenomas of the pancreas. Is enucleation an adequate operation?.Ann Surg. 1998; 227: 896-903
- Essentials of human anatomy.in: Oxford University Press, New York1988: 450-455
- Development of the human pancreas: variations and pathology. A tentative classification.Anat Clin. 1984; 5: 275-283
- Surgical embryology and anatomy of the pancreas.Surg Clin North Am. 1993; 73: 661-697
- Embryologic bases of extended radical resection in pancreatic cancer.Arch Surg. 1998; 133: 297-301
- The use of avidin-biotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabeled antibody (PAP) procedures.J Histochem Cytochem. 1981; 29: 577-580
- Identification of a lobe in the adult human pancreas rich in pancreatic polypeptide.Diabetologia. 1979; 17: 361-365
- Differences of the ventral and dorsal anlagen of pancreas after fusion.Acta Pathol Jpn. 1981; 31: 583-589
- A histopathological study on the etiology of duodenal diverticulum related to the fusion of the pancreatic anlagen.Am J Gastroenterol. 1983; 79: 335-338
- Study of surgical anatomy for duodenum-preserving resection of the head of the pancreas.Ann Surg. 1995; 221: 359-363
- Blood supply to the pancreatic head, bile duct, and duodenum: evaluation by CT during arteriography.Arch Surg. 1999; 134: 1086-1090
- Hypoechogenic embryologic ventral aspect of the head and uncinate process of the pancreas: in vitro correlation of US with histopathologic findings.Radiology. 1994; 190: 441-444
- Patency of the accessory pancreatic duct in relation to its course and shape: a dye-injection endoscopic retrograde pancreatography study.Am J Gastroenterol. 1998; 93: 2135-2140
- Pancreatic development and anatomical variations.Gastrointest Endosc Clin N Am. 1995; 5: 1-30
- Spatial arrangement of the pancreatic ducts in the head of the pancreas with special reference to the branches of the uncinate process.Surgery. 1999; 125: 178-185
- Embryological fusion between the ducts of the ventral and dorsal primordia of the pancreas occurs in two manners.Pancreas. 1997; 14: 407-414
- A study of the pancreatic duct system in man by the use of vinyl acetate casts of postmortem preparations.Surg Gynecol Obstet. 1960; 110: 391-403
- Pancreatic mucin-producing tumor arising in the embryologically dorsal component of the head.Int J Pancreatol. 1998; 23: 77-80
- Pancreas divisum. A predisposing factor to pancreatitis?.Int J Pancreatol. 1989; 5: 317-326
- Resection for pancreatitis in patients with pancreas divisum.Ann Surg. 1984; 200: 590-594
- Surgical management of pancreas divisum.Am J Surg. 1982; 143: 107-112
Article info
Publication history
Accepted:
April 29,
2000
Footnotes
*Supported in part by grants-in-aid for scientific research from the Ministry of Education, Science and Culture, and from the Ministry of Health and Welfare of Japan.
**Reprint requests: Yoshihiro Sakamoto, MD, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyoku, Tokyo 113-8655, Japan.
★Surgery 2000;128:822-31.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
