Surgical procedure for PD and treatment of postoperative complication

Patients with malignant tumor underwent D2 lymph node dissection.^16,17,18,19 When the superior mesenteric and portal veins were involved, they were resected and reconstructed. The pancreas was severed with a surgical scalpel. For reconstruction, the cut end of jejunum was moved up retrocolically. A reconstruction was performed by a modified Child's methods. One or two peritoneal drainage tubes (6.3-mm closed drains) were placed. Abdominal complications such as POPF, abdominal abscess and post-pancreatectomy hemorrhage were usually treated by ongoing drainage, ultrasonography-guided or computed tomography-guided drainage, or surgical intervention. However, when those measures failed to control these complications, reoperation was performed promptly before patients developed more severe complications such as sepsis or shock. In this study, the board certified surgeon of the Japan Surgical Society (JSS) qualified a trainee to perform PD as an operator.²⁰ Certification of the board-certified surgeon of JSS has provided the foundations for board-certified surgeon systems of subspecialty surgical societies.²⁰ The trainees performed PD as an operator under appropriate supervision by a scrubbed senior surgeon as the first assistant.