Living Donor Pancreatectomy

The living related pancreas transplantation was pioneered at the University of Minnesota. The procedure has not been without complications. Some of the donors have become diabetic themselves following hemipancreatectomy. Briefly, a bilateral subcostal incision is performed and the gastrocolic omentum is divided, preserving the epiploic vascular arcade and short gastric vessels. The splenic artery and vein are isolated and suture ligated near the splenic hilum. Care is taken to preserve the spleen. The dissection is carried out to the pancreatic neck, at the confluence of the splenic and SMV (i.e., the origin of the portal vein). The splenic vein is isolated and encircled at its termination in the portal vein. The splenic artery, at the origin of the celiac trunk, is identified behind the pancreatic neck and encircled. Heparin (40 U/kg) is given and the splenic vessels at the origin are transected. The pancreas is divided over the portal vein and then removed and flushed with heparinized cold UW solution on the backtable. The splenic vessels are oversewn on the donor, as are the pancreatic duct and the cut surface of the proximal pancreas. A drain is placed in the pancreatic bed, and the abdomen is closed in the usual fashion.

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