PMC7503790_01
Arterial (a) and portal (b) contrast enhancement abdominal computed tomography (CT) showing a 3 cm pancreatic ductal adenocarcinoma located in the uncinate process and defined as borderline resectable (BR-PDAC) because of a contact with superior mesenteric artery and portal vein <180  (black arrows).
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An abdominal computed tomography (CT) with intravenous contrast enhancement revealed a 3 cm lesion located in the uncinate process of the head of the pancreas with a dilatation of bile (intra-/extra-hepatic) and main pancreatic ducts (Fig. 1) and atrophy of distal part of the gland.
Glutaraldehyde-fixed autologous peritoneo-fascial graft (APG) harvested on posterior rectus fascia, tubulized (peritoneal surface inside) with a vascular stapler (a) and sutured between superior mesenteric (SMV) and portal vein (PV) to achieve the total portal vein (PV) replacement (blue arrow) (b). Splenomesenteric bypass performed with an end-to-end anastomosis between splenic artery and distal stump of the superior mesenteric artery (SMA) (red arrow) (b).
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The APG graft was then tubulized (peritoneal surface inside) with a vascular stapler around a Hegar bougie appropriately chosen according the PV diameter (Fig. 2). PV to achieve the total PV replacement with two hemi-circumferential running sutures of 5-0 monofilament (Fig. 2). Per-operative ultrasound of the liver demonstrated normal intra-hepatic portal vein flow.