Left Gastric Artery Reconstruction after Distal Pancreatectomy with Celiac Axis En-Bloc Resection: How We Do It.

BACKGROUND/AIMS: Ischemic gastropathy remains as a persistent problem after left gastric artery (LGA) resection in distal pancreatectomy with celiac axis en-bloc resection (DP-CAR). The middle colic artery (MCA) was found to be a useful vessel for compromised collateral flow. However, intraoperative gross evaluation of gastric ischemia is technically difficult even after artery reconstruction.

METHODS: We performed LGA reconstruction by MCA-LGA bypass after LGA-resecting DP-CAR assisted by intraoperative indocyanine green fluorescence imaging (ICG) blood flow evaluation in a clinical trial (UMIN000020414). The LGA was reconstructed with the MCA microscopically by plastic surgeons with an everting interrupted suture in end-to-end anastomosis.

RESULTS: We could evaluate ICG blood flow not only in the reconstructed artery, but also simultaneously in the gastric wall through a monitor connected to a detector. We could also assess the congestive status of the gastric wall by ICG disappearance from the gastric wall.

CONCLUSION: We present LGA reconstruction by MCA-LGA bypass after LGA-resecting DP-CAR. We conducted a perioperative assessment of ischemic gastropathy to confirm the feasibility and safety of this procedure.