STEP 3Exposure of the SMV alongside the head of the pancreas

Importantly, it is not necessary to free the portal vein beneath the neck of the pancreas.

The SMV should be exposed adjacent to the head and uncinate process of the pancreas to provide optimal exposure.

Exposing the head and uncinate process is important not only for the coring out process, but also to provide an adequate rim of pancreatic tissue to which the Roux-en-Y jejunal limb is to be sewn.

Free up the small veins and arteries from the head side of the SMV (arteriovenous tributaries).

Divide the venous tributaries to the SMV from the third portion of the duodenum inferiorly; note that the inferior pancreatoduodenal artery on occasion may run anterior rather than posterior to the SMV.

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