Transposition of an Aberrant Right Hepatic Artery on the Gastroduodenal Artery During Pancreatoduodenectomy for Cancer: Technique and Outcomes at a Specialized Vascular Pancreatic Surgery Center.

Abstract

An aberrant right hepatic artery (rHA) arising from the superior mesenteric artery (SMA) is present in about 10%-23% of the patients. There has been extensive debate about oncologic significance related to the presence of rHA, during pancreatoduodenectomy (PD) for pancreatic adenocarcinomas, and some authors suggested that rHA should be sacrified to avoid opening of peritumoral planes. Once rHA had been resected, three different surgical strategies have been described: resection without reconstruction, preoperative embolization followed by resection without reconstruction, and resection with arterial reconstruction. In this technical report, we describe our institutional experience with transposition of rHA on the gastroduodenal artery (GDA) after resection of aberrant rHA at our specialized pancreatic vascular surgery unit. This technique, used in 22 consecutive patients, entails direct reimplantation of the rHA into the GDA stump using 8/0 sutures after having trimmed anastomotic ends by spatulation. Technical advantages and drawbacks are presented and discussed. Transposition of an rHA on the GDA represents a valid surgical alternative for arterial reconstruction during PD in specialized vascular pancreatic surgery center.