SURGICAL TECHNIQUES Preparation for transplant

SURGICAL TECHNIQUES Preparation for transplant

Once the organ has been inspected and is deemed suitable for transplant it needs to be prepared for implantation. This is a crucial step and meticulous attention to detail and a systematic approach are vital to minimise bleeding and complications after reperfusion. The pancreas is retrieved with the spleen attached, a length of duodenum and the cut ends of the SMA, SA and PV ( Figure 90.2 ). The splenic vessels are ligated and the spleen removed; the duodenum is shortened, stapled and the staple lines buried with a suture. Excess fat and omentum are removed, and the cut end of the inferior mesenteric vein ligated. An arterial ‘Y-graft’ is usually fashioned between the SMA and SA of the pancreas using donor iliac vessels, so that the end of the common iliac artery (CIA) can be used for a single arterial anastomosis ( Figure 90.1 ).