Reconstruction of the Common Hepatic Artery at the Time of Total Pancreatectomy Using a Splenohepatic Bypass

Arterial involvement by a periampullary adenocarcinoma is often a contraindication for resection, since an R0 resection cannot be achieved. This is usually observed in cases with involvement of the superior mesenteric artery. Involvement of the common hepatic artery, however, requires a bypass procedure if the gastroduodenal artery was divided during the resection. In such cases, the splenic artery can be used as an inflow-source provided that there is no stenosis of the celiac trunk and the splenic blood flow is preserved via the short gastric arteries. We describe a technique used in four cases for the reconstruction of the common hepatic artery following a segmental resection of this vessel en bloc with a periampullary tumor during pancreatectomy. The inflow is maintained by a splenohepatic bypass using the splenic artery.