[Surgical anatomy of the pancreas with special reference to arterial and venous vascularization of the corporeo-caudal segment]

Thrombosis accounts for 10-20% of the complications that follow human pancreas transplants. The extent to which this is determined by the vascularisation of the transplanted caudocorporeal segment is uncertain. An account is given of the literature data on the surgical anatomy of the pancreas as a whole and a detailed examination is made of the vascularisation of its left segment. Most workers feel that the arterial axis is sufficient to ensure an optimum vascular support. It has been shown, however, that in 25% of cases that branches issuing from the right-hand system (hepatic, superior mesenteric and colic arteries) and insufficiently anastomosed with the splenic artery are also of importance. This suggests that: a preoperative study should be made of the vascular system of the transplant; a double anastomosis should be created between the donor splenic and pancreatic arteries and the host vessels; particular care should be taken to prevent damage to vessels of fundamental importance to the nutrition of the pancreas when the transplant is removed.