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Fig. 7.4. Backbench preparation of the pancreaticoduodenal allograft.

E. Pancreas Transplant Surgery

The surgical techniques for pancreas transplantation are diverse and there is no standard methodology used by all programs (Figs. 7.5-7.7).

The principles are consistent, however, and include providing adequate arterial blood flow to the pancreas and duodenal segment; adequate venous outflow of the pancreas via the portal vein; and management of the pancreatic exocrine secretions. The native pancreas is not removed. Pancreas graft arterial revascularization is typically accomplished utilizing the recipient right common or external iliac artery. The Y-graft of the pancreas is anastomosed end-to-side. Positioning of the head of the pancreas graft cephalad or caudad is not relevant with respect to successful arterial revascularization. There are two choices for venous revascularization, systemic and portal. Systemic venous revascularization commonly involves the right common iliac vein, or right external iliac vein following suture-ligation and division of the hypogastric veins. If portal venous drainage is utilized, it is necessary to dissect out the superior mesenteric vein (SMV) at the root of the mesentery. The pancreas portal vein is anastomosed end-to-side to a branch of the SMV. This may influence the methodology of arterial

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