A complete physiological orthotopic living related partial pancreatic transplantation alone with pancreatic duct to duct anastomosis for type I diabetes mellitus.

ABSTRACT

In this study, we reported a complete solitary living related orthotopic partial pancreatic transplantation (LROPPT) with duct to duct drainage of pancreatic juice. A 29-year old man, who has suffered from type I diabetes mellitus (DM) since age 2, underwent LROPPT on 2007 August 9th. He had hypoglycemia for several times per week. His preoperative hemoglobin A1c (HbA1c) was 8.4%. He has little diabetic complications of 2 degree of nephropathy with albuminuria and slight neuropathy. The donor was a 57-year old his father, whose preoperative 75gOGTT and ivGTT revealed normal pattern. Donor was performed hand-assisted distal pancreatectomy with spleen. Operative time was 5 hours and 18 min and intraoperative hemorrhage was 75 ml. Recipient was explored by upper abdominal L-shaped incision. Distal pancreatectomy with spleen with enough expose of both splenic vein and artery, and main pancreatic duct. Both the splenic vein and the arterial anastomosis was made, thereafter, pancreatic duct to duct anastomosis was made by 6-0 PDS with pancreatic duct stent. The pancreatic duct stent lead to extra abdomen through Papilla Vater and duodenum. Pancreatic tissue was anastomosis by 6-0 prolene using fibrin-glue. After that, absorbed thin mesh was rolled around the pancreatic anastomosis with fibrin-glue. The operative time was 10 hr 10 min and the blood loss was 435 ml. Patient was discharged without a pancreatic leakage and vessel thrombosis 16th days after transplantation. LROPPT is a complete physiologic procedure. In Japan, almost of donor is marginal donor aged above 50 years old. The portal drainage might be comfortable for the stress of the partial pancreatic graft.