Establishment of a pig model with enteric and portal venous drainage of pancreatoduodenal transplantation

AIM： To establish the pig model of pancreatoduodena transplantation with enteric drainage （ED） and porta venous drainage （PVD）. METHODS： Forty-six hybrid Landrace pigs were divided into two groups （donors and recipients） randomly, and pancreatoduodenal allotransplantation was performed. Donors were perfused via abdominal aorta without clamping the portal venous outflow with UW solution at 80-100 cm H2O after heparinization. Whole pancreatoduodenal grafts were harvested with segments of abdominal aorta and portal vein, and shaped under 4℃ UW solution. Then, end-to-end anastomosis was performed with the donor iliac artery bifurcation Y graft to the recipient superior mesenteric artery and celiac artery. Furthermore, type I diabetes model was made by removal of the recipient pancreas. The venous anastomosis was reconstructed between the donor portal vein and the recipient superior mesentery vein. Meanwhile, end-toside anastomosis was performed with the donor common iliac artery bifurcation Y graft to the recipient abdominal aorta, and side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum. External jugular vein was intubated for transfusion. Levels of plasma glucose, insulin and glucagon were measured during the operation and on the 1^st 3^rd 5^th and 7^th d after operation. RESULTS： Pancreatoduodenal allotransplantation was performed on 23 pigs of which 1 died of complication of anesthesia. The success rate of operation was 95.6%. Complications of operation occurred in two cases in which one was phlebothrombosis with an incidence of 4.6%, and the other was duodenojejunal anastomotic leak with an incidence of 4.6%. The level of plasma glucose decreased within 30 min, after removal of pancreas and recovered on the 2^nd after operation. The level of plasmainsulin and glucagon increased within 30 min after removal of pancreas and recovered on the 2^nd d after operation. Rejection occurred on the 1^st and reached the worst level on the 7^th d after transplantation, without change of plasma insulin and glucagon or clinical symptoms of rejection. CONCLUSION： Pancreatoduodenal transplantation in pigs can treat type I diabetes. ED and PVD can keep the function of endocrine in normal. The technique of pancreatoduodenal transplantation with ED and PVD may pave the way for the further application of pancreas transplantation in clinic.

Establisment of a novel pig model of pancreatoduodenal allotransplantation

BACKGROUND: Pancreas transplantation is a valid thera- py for patients with type 1 diabetes mellitus (IDDM). This study was undertaken to establish a stable pig model of whole pancreatoduodenal allotransplantation of physiologi- cally coincidence for pancreas transplantation. METHODS: The IDDM pig model was made by resection of the pancreas from the recipient. The portal vein of the donor was end-to-side anastomosed to the anterior mesen- teric vein (equal to the superior mesenteric vein) or the portal vein of the recipient. The far end of the celiac axis was anastomosed to each other. With end-to-side fashion, the duodenum of the donor was anastomosed to the jeju- num of the recipient. RESULTS: In 16 transplantations, results were satisfactory. The anatomical results and immune function including the function of the pancreas were similar to those of human be- ing. CONCLUSION: Of the pancreas of the pig, this study of pancreatic transplantation shows that the novel pig whole pancreatoduodenal allotransplantation model is ideal.

Nakao mesenteric approach in pancreatoduodenectomy for pancreatic head cancer

The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy(PD);that is,en bloc resection using a non-touch isolation technique.We have been developing isolated PD for pancreatic cancer since 1981,when we developed an antithrombogenic bypass catheter for the portal vein.In this operation,the first and most important step is the use of a mesenteric approach instead of Kocher’s maneuver.The mesenteric approach allows dissection from the non-cancer infiltrating side and determination of cancer-free surgical margins and resectability,followed by systemic lymphadenectomy around the superior mesenteric artery.This approach enables early ligation of the inferior pancreatoduodenal artery and mesopancreas excision.The mesopancreas is the second portion of the pancreatic head nerve plexus.Isolated PD is the ideal surgery for pancreatic head cancer from both surgical and oncological viewpoints.In patients with resectable pancreatic head cancer,isolated PD using the mesenteric approach is suspected to have a higher survival rate than conventional PD using Kocher’s maneuver.The precise surgical techniques of the mesenteric approach are herein described.