Hanging Maneuver in Pancreaticoduodenectomy: A safe method of Pancreatic amputation with Concomitant Pancreatitis

Author(s): Satoshi Mizutani, Nobuhiko Taniai, Kotaro Nanno, Hiroyasu Furuki, Hideyuki Takata, Junji Ueda, Masato Yoshioka, Takayuki Aimoto, Yoshiharu Nakamura, Hiroshi Yoshida

Introduction: Pancreatic transection is a crucial step in pancreaticoduodenectomy for pancreatic head cancer, which often leads to concomitant pancreatitis. The aim of pancreatic transection is to dissect only the pancreatic parenchyma without damaging the common hepatic artery (CHA), splenic artery (SpA), portal vein, or splenic vein. We demonstrate that a hanging maneuver using two cotton tapes enables the safe and uniform transection of pancreatic head cancer with concomitant pancreatitis.

Methods: This hanging maneuver has three steps. In the first step, the area around the SMA up to the celiac plexus must be dissected. In the second step, the CHA is dissected from beyond the bifurcation of the Celiac Axis to the SpA. The third step, involves passing two cotton tapes through the planned pancreatic cut line. These three steps make pancreatic transection safe and uniform. The hanging maneuver has been performed in 30 cases of pancreaticoduodenectomy for pancreatic head cancer with severe concomitant pancreatitis.

Results: No significant differences were observed in any of the items between the hanging maneuver for concomitant pancreatitis group and the conventional pancreaticoduodenectomy without concomitant pancreatitis group.

Conclusions: Pancreatic transection using the hanging maneuver is an effective and safe approach to pancreaticoduodenectomy with concomitant pancreatitis.