A case report of pancreaticoduodenectomy after coronary artery bypass operation using a right gastroepiploic artery graft

Abstract

We report a case of subtotal stomach-preserving pancreaticoduodenectomy after coronary artery bypass operation using a right gastroepiploic artery graft. The case involved an 80-year-old man who had been performed coronary artery bypass operations at the ages of 55 and 78 years. This time obstructive jaundice was suspected from high fever and jaundice and cancer of the lower bile duct was diagnosed following close examinations. Considering the clinical stage of the disease before surgery and his advanced age, we performed subtotal stomach-preserving pancreaticoduodenectomy with the gastroduodenal artery intact. During surgery, we confirmed that vascular treatment had been done at the greater curvature aspect of the gastric pylorus ; and that the right gastroepiploic artery graft which was the periphery of the gastroduodenal artery showed favorable pulsation and run toward the cranial direction to the mediastinum on the ventral aspect of the lateral area of the liver. At surgery, dissection of the stomach was performed first, and then under direct vision, the gastroduodenal artery-right gastroepiploic artery graft was treated from the widely exposed anterior surface of the pancreas head, and a branch of the pancreaticoduodenal artery was treated from the periphery to the base of the gastroduodenal artery. By employing these procedures, we could perform the surgery relatively easily. No noteworthy postoperative complications occurred and the patient's postoperative course was uneventful.