Anatomical Variants of the Jejunal Veins and Their Technical Implications in Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis.

Introduction: One of the most common causes of bleeding during pancreaticoduodenectomy is a dissection of the pancreatic head from the superior mesenteric vein and superior mesenteric artery. Knowledge of the anatomical variants of the veins draining the proximal jejunum may allow better control of bleeding during detachment of the uncinate process and pancreatic head from the mesenteric pedicle and division of the mesopancreas. The aim of this systematic review and meta-analysis was to evaluate the anatomical variations of the first jejunal vein (FJV) and jejunal trunk (FJT).

Methods: Fourteen studies (1,888 patients) were included. We performed a systematic review of the available literature according to PRISMA guidelines.

Results: The analysis has shown that the posterior course of the FJT and FJV represents the most frequent topographical location (pooled prevalence estimate [PPE] 79.6%) with the anterior jejunal trunk having a lower rate (PPE 20.4%). Few articles reported the variations with separate trunks for the first and second jejunal veins.

Conclusions: A thorough preoperative radiological assessment of the anatomical variation of FJT and FJV may confer some advantage to establish the best therapeutic strategy and the best surgical approach in case of pancreatic head carcinoma as it can allow a better estimate of the extent of the neoplasm and improve the accuracy of surgical dissection with potential for reduced bleeding.