STEP 5Portomesenteric anastomosis

Whenever possible, the venous anastomosis should be performed without an additional venous graft to decrease the risk of venous thrombosis. For this procedure, the colon is not mobilized. The small intestine is retracted to the left, and the superior mesenteric vein is located caudal to the transverse mesocolon. An incision is made about 20 mm lateral of the vein to allow a better control of this vein while positioning the pancreas graft. The venous anastomosis is performed with the same technique described above. For the arterial anastomosis, the common iliac artery is palpated medial to the ileocolic artery through the mesocolon, and the mesentery opened for 4-5 cm to expose the common iliac artery. The anastomosis is performed through the mesentery using the same technique as above.

This approach speeds the procedure and avoids complete mobilization of the right colon. The retroperitoneum is not opened, decreasing the risk of postoperative hemorrhage. Whether benefit is achieved through a portomesenteric versus systemic venous drainage is still debated.

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