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Ferreira GM, Pantanali CAR, Mantovani MDC, Ferreira CL, De Melo HC, Sogayar MC, Chaib E, D'Albuquerque LAC, Galvão FHF. Anatomic and Surgical Aspects of Total Pancreatectomy in Swine. Transplant Proc 2024:S0041-1345(24)00260-4. [PMID: 38890075 DOI: 10.1016/j.transproceed.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/26/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The swine is a valuable model for preclinical research and surgical technique training. Induction of Type I diabetes is achieved by total pancreatectomy, therefore these animals may be used in several research studies, including islet transplantation field. Given the lack of information in the literature, the purpose of this work is to describe anatomic aspects of swine pancreas, the total pancreatectomy surgical technique, intra- and postoperative complications and the autopsy results. MATERIAL AND METHODS Five hybrid male pigs, 20-35 kg, submitted to total pancreatectomy with duodenum, bile duct, and spleen preservation. Postoperatively, daily clinical assessment and capillary blood glucose collection were performed. At the end of the 30-day period or in the occurrence of serious clinical complications, euthanasia and autopsy were performed. RESULTS The average duration of surgery was 128 minutes, without intraoperative deaths or anesthesia induction failures. The median survival was 6.6 days. Postoperative complications were weight loss (3), emesis (2), constipation (2), abdominal distension (2), diarrhea (1), and loss of appetite (1). All animals were euthanized due to serious complications. Two animals presented surgical complications (duodenal necrosis with gastroparesis and internal hernia with intestinal necrosis). The other 3 animals presented serious clinical complications related to exocrine pancreatic insufficiency due to deficiency of pancreatic enzymes. Glycemic values above 200 mg/dL were found on the first postoperative day and above 300 mg/dL on the seventh day in all animals. CONCLUSION A model of total pancreatectomy with duodenum, spleen, and bile duct preservation in pigs was established. All animals became diabetic, however, animals without postoperative complications were euthanized due to serious complications related to pancreas exocrine insufficiency.
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Affiliation(s)
- Giovanna Mattos Ferreira
- Laboratory of Medical Investigation 37, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carlos Andres Rodriguez Pantanali
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marluce Da Cunha Mantovani
- Cell and Molecular Therapy Center (NUCEL), School of Medicine, University of São Paulo, São Paulo, Brazil; Technical Division for Teaching, Research and Innovation Support (DTAPEPI), Biotechnology and Innovation Facility, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Cinthia Lanchotte Ferreira
- Laboratory of Medical Investigation 37, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Mari Cleide Sogayar
- Cell and Molecular Therapy Center (NUCEL), School of Medicine, University of São Paulo, São Paulo, Brazil; Biochemistry Department, Chemistry Institute, University of São Paulo, São Paulo, Brazil
| | - Eleazar Chaib
- Laboratory of Medical Investigation 37, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil; Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luiz Augusto Carneiro D'Albuquerque
- Laboratory of Medical Investigation 37, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil; Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Flávio Henrique Ferreira Galvão
- Laboratory of Medical Investigation 37, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil; Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil.
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Fonouni H, Tahmasbi Rad M, Esmaeilzadeh M, Golriz M, Majlesara A, Mehrabi A. A Simplified Technique of Pancreas Transplantation in a Porcine Model. Eur Surg Res 2014; 54:24-33. [DOI: 10.1159/000367844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/22/2014] [Indexed: 11/19/2022]
Abstract
Background: The incidence of diabetes has been steadily increasing. The only curative option for diabetes is pancreas transplantation (PTx). Porcine models are valuable because of their anatomical and physiological similarities to human beings. Our aim is to introduce a simplified technique of PTx in a porcine model. Methods: In Landrace pigs (n = 32), after median laparotomy, the pancreas was mobilized, and the portal and splenic veins were divided. The proper hepatic and splenic arteries and the bile duct were also prepared, and the duodenal bulb was prepared and stapled. The third portion of the duodenum was freed up to the ligament of Treitz and stapled, and the renal arteries were ligated. After systemic heparinization, the pancreas was perfused through the abdominal aorta with histidine-tryptophan-ketoglutarate solution. The portal and splenic veins were cut for evaluating the sufficiency of perfusion. Whole pancreaticoduodenal graft was procured along with an aortic jump graft containing mesenteric and celiac trunks. In recipients, after total pancreatectomy, the suprarenal inferior vena cava and infrarenal aorta were prepared for vascular anastomosis in an end-to-side manner. After pancreas reperfusion, duodenoduodenostomy was performed in an end-to-side manner. Results: Median cold and warm ischemia times were 10 h (range, 9-14 h) and 50 min (range, 35-80 min), respectively. The hemodynamic status was stable throughout the operation. The median follow-up period was 7 days (range, 4-10). There were no major intra- and postoperative complications. Conclusion: By using an aortic jump graft, there was no need to perform additional arterial reconstruction resulting in a short warm ischemic and operation time. End-to-side portocaval and duodenoduodenal anastomoses make this model of PTx a very feasible method for experimental evaluations.
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