E

Figure 15-4 continued. Pylorus-preserving pancreaticoduodenectomy for large or potentially malignant islet cell tumors of the head of the pancreas. E, (1) The gastroduodenal artery is ligated. (2) Division of the distal CBD. (3) Division of the neck of the pancreas. F, (1) Small branches from the portal vein to the head of the pancreas are divided between five ligatures. (2) Three branches from the superior mesenteric artery are divided and ligated to free the pancreas and uncinate. G, A two-layer anastomosis of the pancreas to the jejunum is made over a small Silastic stent placed in the main pancreatic duct. H, A two-layer duodenum to jejunum anastomosis and a single-layer choledocojejunostomy (arrow).

Figure 15-4 continued. Pylorus-preserving pancreaticoduodenectomy for large or potentially malignant islet cell tumors of the head of the pancreas. E, (1) The gastroduodenal artery is ligated. (2) Division of the distal CBD. (3) Division of the neck of the pancreas. F, (1) Small branches from the portal vein to the head of the pancreas are divided between five ligatures. (2) Three branches from the superior mesenteric artery are divided and ligated to free the pancreas and uncinate. G, A two-layer anastomosis of the pancreas to the jejunum is made over a small Silastic stent placed in the main pancreatic duct. H, A two-layer duodenum to jejunum anastomosis and a single-layer choledocojejunostomy (arrow).

Pancreas

Stay sutures on proximal CBD

Pancreas

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