Backtable Preparation

The backtable preparation of the pancreas involves trimming and oversewing of redundant duodenum. The ampulla of Vater must be in plain sight so as not to compromise it. Safe anastomosis necessitates 6-8 cm of duodenum. Fibrofatty tissue surrounding the pancreas is ligated, as are the inferior mesenteric vein, the gastroduodenal artery, and the middle colic vessels. Some groups perform splenectomy on the backtable, while others wait until reperfusion and use the spleen as a handle during the operation. The splenic and superior mesenteric arteries are reconstructed using the donor iliac artery. The internal iliac is anastomosed to the splenic mesenteric artery and the external iliac artery is anastomosed to the superior mesenteric artery (SMA) on the backtable with 5-0 or 6-0 running nonabsorb-

Figure 12.1. Bladder and systemic drainage.
Figure 12.2. Enteric and portal drainage.

able suture. This provides one orifice for subsequent arterial anastomosis on the operating table later on. If there are no suitable iliac grafts, the donor's brachio-cephalic trunk can be used. Additionally, the splenic artery may be anastomosed, with or without an interposition graft, end-to-side to the SMA. Placing the portal vein on traction with stay sutures facilitates venous reconstruction. The coronary vein, as well as small tributaries draining the head of the pancreas, should be ligated, as their subsequent tearing may precipitate troublesome hemorrhage. Two centimeters of portal vein are necessary for safe reconstruction. If this is not the case, elongation of the vein can be performed with a jump graft of iliac vein from the cadaver.

Baby Sleeping

Baby Sleeping

Everything You Need To Know About Baby Sleeping. Your baby is going to be sleeping a lot. During the first few months, your baby will sleep for most of theday. You may not get any real interaction, or reactions other than sleep and crying.

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