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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 24, 2016; 6(2): 255-271
Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.255
Exocrine drainage in vascularized pancreas transplantation in the new millennium
Hany El-Hennawy, Robert J Stratta, Fowler Smith
Hany El-Hennawy, Robert J Stratta, Fowler Smith, Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
Author contributions: El-Hennawy H and Stratta RJ studier conception, designs, acquisition of data, analysis and interpretation of data; all the authors do drafting of manuscript and critical revision.
Conflict-of-interest statement: The authors acknowledge that the above manuscript represents original work that has not been previously published or submitted for publication. There are no conflicts of interest, grant support, sponsorship, or other financial arrangements to report by any of the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Robert J Stratta, MD, Department of Surgery, Wake Forest School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157, United States. rstratta@wakehealth.edu
Telephone: +1-336-7160548 Fax: +1-336-7135055
Received: February 16, 2016
Peer-review started: February 16, 2016
First decision: March 1, 2016
Revised: May 6, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: June 24, 2016
Processing time: 127 Days and 11.4 Hours
Core Tip

Core tip: The history of vascularized pancreas transplantation largely parallels advances in surgical techniques. Prior to 1995, most pancreas transplants were performed with delivery of insulin to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder (systemic-bladder technique). Starting in 1995, however, a seismic change occurred from bladder to bowel drainage of the pancreatic secretions that was spurred in part by the success of enteric conversion. In the new millennium, most pancreas transplants are performed as pancreatico-duodenal grafts with either iliac vein and bowel exocrine diversion (systemic-enteric technique) or portal-enteric drainage. With refinements in surgical techniques, exocrine drainage is no longer considered the “Achilles’ heel” of pancreas transplantation.