Modak Shreeyash, Tilloo Raviraj, Ahmed Zeeshan, Karunakaran Monish, Patil Sanjeev, Shetty Mahesh, Dama Rohit, Rebala Pradeep, Rao Guduru Venkat
Department of Surgical Gastroenterology, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad, India.
Ann Hepatobiliary Pancreat Surg. 2025 Aug 31;29(3):308-316. doi: 10.14701/ahbps.25-027. Epub 2025 May 23.
BACKGROUNDS/AIMS: Portal annular pancreas (PAP) is an anomaly where pancreatic tissue surrounds the portal vein (PV). We present a case series from our institution and a systematic review of PAP patients who underwent pancreatoduodenectomy (PD).
We conducted a retrospective review of patient records from a tertiary referral center, from January 2014 to June 2024, who underwent PD to identify those with PAP. Additionally, a literature search was performed and articles discussing PAP patients who underwent PD were included.
The incidence of PAP was 0.4% (7 out of 1,750 PD cases). Of these, three (42.85%) patients developed clinically relevant postoperative pancreatic fistula (CR-POPF). Following the literature review, 34 articles with 57 patients (including our study) were considered. Reconstruction of the dominant stump, which included the main pancreatic duct, was performed using pancreatojejunostomy in 88.88% of cases and pancreatogastrostomy in 11.11% of cases. The non-dominant stump was managed with en-bloc extended resection (ER) of PAP, leftward of the PV, offering a single-cut surface for pancreatojejunostomy (41.51%), by stapling (26.41%) or suturing the stump (16.98%), stump-pancreatogastrostomy (5.66%), and electrocautery (5.66%). CR-POPF rates for ER, suturing and stapling were 22.72%, 37.5%, and 53.85%, respectively ( = 0.12).
Preoperative recognition of PAP is crucial to customize surgical procedures to effectively manage the non-dominant stump.
背景/目的：门静脉环周胰腺（PAP）是一种胰腺组织环绕门静脉（PV）的异常情况。我们展示了来自我们机构的一系列病例，并对接受胰十二指肠切除术（PD）的PAP患者进行了系统回顾。
我们对2014年1月至2024年6月在一家三级转诊中心接受PD的患者记录进行了回顾性研究，以确定患有PAP的患者。此外，进行了文献检索，并纳入了讨论接受PD的PAP患者的文章。
PAP的发生率为0.4%（1750例PD病例中有7例）。其中，3例（42.85%）患者发生了临床相关的术后胰瘘（CR-POPF）。经过文献回顾，共纳入34篇文章，涉及57例患者（包括我们的研究）。在88.88%的病例中，使用胰空肠吻合术重建包含主胰管的主要残端，在11.11%的病例中使用胰胃吻合术。非主要残端通过在门静脉左侧对PAP进行整块扩大切除（ER）来处理，为胰空肠吻合术提供单一切割面（41.51%），通过吻合器（26.41%）或缝合残端（16.98%）、残端-胰胃吻合术（5.66%）和电灼术（5.66%）。ER、缝合和吻合器吻合的CR-POPF发生率分别为22.72%、37.5%和53.85%（P = 0.12）。
术前识别PAP对于定制手术方案以有效处理非主要残端至关重要。
