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Pancreaticoduodenectomy (PD) is the treatment of choice for malignant and several benign conditions of the pancreatic head and periampullary region [1–4].

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While performing pancreaticoduodenectomy, early neck division may be impossible or inadequate in case of hepatic artery anatomic variants, suspected involvement of the superior mesenteric vessels, intraductal papillary mucinous neoplasm, and pancreatic head bleeding pseudoaneurysm. Thirty-two had hepatic artery anatomic variant and 2 had bleeding pancreatic head pseudoaneurysm.

Our work aims to highlight a particular hind right approach pancreaticoduodenectomy in selected indications and assess the preliminary results. We describe our early hind right approach to the retropancreatic vasculature during pancreaticoduodenectomy by mesopancreas dissection before any pancreatic or digestive transection. The hepatic artery variant was preserved in all cases out of 2 in which arterial reconstruction was performed.

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