D. Backbench Preparation of the Pancreas Allograft

The backbench preparation of the pancreas allograft for transplantation requires careful and meticulous surgical technique to ensure a properly Ā«vascularized pancreas with adequate duodenum and minimal extraneous fibrotic or adipose tissue.4 The pancreaticoduodenosplenic allograft is placed in a basin with chilled UW preservation solution. The duodenum should be opened, drained, and irrigated into a separate container. Some programs routinely culture the fluid and a small piece of duodenal tissue.

The main principles in allograft preparation are as follows (Fig. 7.4): to separate the spleen from the pancreas tail with secure ligatures on the large splenic vessels. Next it may be useful to cannulate the common bile duct with a 5F feeding tube to identify the location of the ampulla and ensure its center position as the proximal and distal duodenum are shortened to an appropriate length (the tube is removed). The staple line on the root of the mesentery is oversewn for reinforcement. The middle colic vessels are secured. A Y-graft is constructed utilizing the donor iliac artery bifurcation graft as end-to-end anastomoses on the splenic artery and superior mesenteric artery of the pancreas allograft. If a sufficient length of splenic artery can be mobilized, it is possible to perform a direct end-to-side anastomosis to the superior mesenteric artery. The portal vein is carefully mobilized to allow for appropriate length and determination if a short portal venous extension graft utilizing donor external iliac vein would be useful.

Superior Pancreaticoduodenal Vein

Fig. 7.4. Backbench preparation of the pancreaticoduodenal allograft.

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