[Vascular anatomy and its variants in pancreatic surgery].

Abstract

A profound understanding of pancreatic anatomy and its vascular supply is essential for safely performing complex surgical procedures such as pancreaticoduodenectomy. Historically, anatomical exploration began with Herophilos and Ruphos of Ephesos in ancient times, evolving through major surgical innovations by Wirsung, Kausch and Whipple. The pancreas is located secondarily retroperitoneally and therefore has a close relationship of the pancreatic head to the superior mesenteric artery (SMA) and portal vein (PV) and the celiac trunc. Clinically relevant anatomical variants, such as the Rio-Branco and Bühler anastomoses and various forms of the coeliac trunk according to Hiatt's classification are crucial for surgical planning. Venous drainage primarily occurs through the superior mesenteric vein, splenic vein and the gastrocolic trunk of Henle. The "artery first approach" provides various access routes to safely identify and expose critical vascular structures, to optimize oncological resection and minimize perioperative complications.