Blood supply to the head of the pancreas and the duodenum and its clinical application

Objective To study blood supply to the head of the pancreas and the duodenum, and provide anatomical basis for Kocher maneuver and protecting vessels of the duodenum during duodenum preserving pancreatic head resection(DPPHR). Methods A total of 40 cadavers were collected for the study.The superior mesenteric artery, the gastroduodenal artery, the anterior pancreaticoduodenal arterial arcade, the posterior pancreaticoduodenal arterial arcade,their branches and accompanying veins were completely exposed.The arterial branches between the head of the pancreas and the duodenum were observed. Results For97.5% cases(n=39), the posterior pancreaticoduodenal arterial arcade and accompanying veins were found in pancreatic fascia. For 90% cases(n=36), it was easy to preserve the anterior inferior pancreaticoduodenal artery and accompanying veins lied in the pancreaticoduodenal groove. For 10% cases(n=4), the anterior pancreaticoduodenal arterial arcade was absent, and 2.5%(n=1) was absent for the posterior pancreaticoduodenal arterial arcade, but the arteries to the duodenum and their accompanying veins were found in pancreatic fascia. Conclusions Protecting the posterior pancreaticoduodenal arterial arcade and the part of the anterior pancreaticoduodenal arterial arcade are the key process for successful DPPHR. Kocher maneuver helps to expose and identify the posterior pancreaticoduodenal arterial arcade and drainage veins. The failure of DPPHR maybe caused by the absence of the anterior pancreaticoduodenal arterial arcade.