Anatomical variants of the jejunal veins and their technical implications in pancreaticoduodenectomy: a systematic review and meta-analysis.

IF 1.8 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Digestive Surgery Pub Date : 2024-10-16 DOI:10.1159/000541417

Roberto Cirocchi, Matteo Matteucci, Justus Randolph, Carlo Boselli, Justin Davies, Gabriele Scarselletti, Alessandro Gemini, Antonia Rizzuto, Giovanni Domenico Tebala

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引用次数: 0

Abstract

Introduction: One of the most common causes of bleeding during pancreaticoduodenectomy (PD) is dissection of the pancreatic head from the superior mesenteric vein (SMV) and superior mesenteric artery (SMA). Knowledge of the anatomical variants of the veins draining the proximal jejunum may allow a better control of bleeding during detachment of the uncinate process and pancreatic head from the mesenteric pedicle and division of the mesopancreas. The aim of this systematic review and meta-analysis is to evaluate the anatomical variations of the first jejunal vein (FJV) and jejunal trunk (FJT).

Methods: Fourteen studies (1,888 patients) were included. We performed a systematic review of the available Literature according to the PRISMA guidelines.

Results: The analysis has shown that the posterior course of the FJT and FJV represents the most frequent topographical location (PPE 79.6%) with the anterior jejunal trunk (JT) having a lower rate (PPE 20.4%). Few articles reported the variations with separate trunks for the first and second jejunal vein.

Conclusions: A thorough preoperative radiological assessment of the anatomical variation of FJT and FJV may confer some advantage to establish the best therapeutic strategy and the best surgical approach in case of pancreatic head carcinoma, as it can allow a better estimate of the extent of the neoplasm and improve the accuracy of surgical dissection with potential for reduced bleeding.

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空肠静脉的解剖变异及其对胰十二指肠切除术的技术影响：系统回顾和荟萃分析。

简介：胰十二指肠切除术（PD）中最常见的出血原因之一是将胰头与肠系膜上静脉（SMV）和肠系膜上动脉（SMA）分离。了解空肠近端引流静脉的解剖变异可在从肠系膜蒂分离钩突和胰头以及分割胰腺间质时更好地控制出血。本系统综述和荟萃分析旨在评估第一空肠静脉（FJV）和空肠干（FJT）的解剖变异：方法：共纳入 14 项研究（1888 名患者）。我们根据 PRISMA 指南对现有文献进行了系统性回顾：分析表明，FJT 和 FJV 的后方走向代表了最常见的地形位置（PPE 79.6%），而空肠前干 (JT) 的发生率较低（PPE 20.4%）。很少有文章报道第一空肠静脉和第二空肠静脉主干分开的变异情况：对 FJT 和 FJV 的解剖变异进行全面的术前放射学评估，可为胰头癌患者制定最佳治疗策略和最佳手术方法提供一些优势，因为这可以更好地估计肿瘤的范围，提高手术切除的准确性，并有可能减少出血。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Surgery 医学-外科

CiteScore

4.90

自引率

3.70%

发文量

审稿时长

3 months

期刊介绍： ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.