Fig. 3

The scheme of intraoperative findings. a Taping of the interposed jejunum. The edge of pancreatic tail is exposed at the left subphrenic portion, and the interposed jejunum and its mesentery lying in front of the pancreas are isolated and taped. b Isolation of the right gastroepiploic conduit. The GDA is divided from the pancreas, and the arcade from the common hepatic artery (CHA) to the right gastroepiploic artery (RGEA) is isolated. The right gastroepiploic vein (RGEV) from the superior mesenteric vein (SMV) is isolated from the pancreas by resecting the branches to the pancreas. c Resection of the splenic artery (SPA) and vein (SPV). By guiding the CHA, the SPA is isolated and resected at the root. The pancreatic body and tail are turned up in front of the remnant stomach, and the root of the SPV is resected. d The resected jejunum is pulled out to the right side, and resection around the superior mesenteric artery plexus is performed with preserving the right hepatic artery (RHA) from the SMA. Finally, the pancreatic head is divided from the pancreatic nerve plexus I (PL-ph I), and the surgical specimen is removed. f Reconstruction route of the jejunum. The jejunal limb for entero-biliary anastomosis is passed through the hole behind the SMA and SMV (retromesenteric route). The jejunum for gastrointestinal anastomosis using the antecolic route and the Braun anastomosis are created. RGEA right gastroepiploic artery, RGEV right gastroepiploic vein, GDA gastroduodenal artery, CHA common hepatic artery, SMV superior mesenteric vein, SPA splenic artery, SPV splenic vein, RHA replaced right hepatic artery, PL-ph I pancreatic nerve plexus I