We prefer to completely prepare the pancreas for transplantation during cold ischemia. All connective tissues around the pancreas are divided with 2-0 or 4-0 silk ligatures placed close to the pancreas. The spleen is resected and the splenic vessels carefully ligated with 0 silk. The superior mesenteric artery and vein distal to the pancreatic vessels are divided in one of two ways: either with a vascular stapler close to the pancreas or by ligating the vessels with 0 silk and oversewing them with polypropylene running sutures. A 12-cm segment of the second portion of the duodenum containing the entrance of the pancreatic duct is isolated using a gastrointestinal stapler. The staple lines are oversewn for hemostasis with a running suture of resorbable suture. The portal vein is usually left short at the procurement; this permits a very short portal anastomosis, which decreases the risk of venous thrombosis. The mesenteric and splenic arteries are connected with use of a Y-graft from the donor iliac bifurcation with running sutures of 6-0 polypropylene. The graft is now ready for implantation.
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