fig0015: Picture showing the abdomen of the patient. The thin lines indicate the locations of the incisions. The short lower line indicates the additional incision made for dissection of the ligament of Treitz. The upper-middle line indicates the incision made for reconstruction.

Mentions: To avoid disturbing the AAA or stimulating a residual AAA, we intended to perform Lap PD. Open laparoscopy was performed at the umbilicus, and an additional five ports were placed (Fig. 3). The patient had severe visceral steatosis, and the abdominal cavity was filled with omental fat. We cautiously performed a subtotal stomach-preserving PD. For mobilization around the ligament of Treitz and the fourth portion of the duodenum, an additional port was placed at the middle of the inferior abdomen (Fig. 3). During this procedure, neither duodenal adhesion to the aorta nor other inflammatory changes due to the previously placed stent graft were observed. No operative manipulations were affected by the caudal side of the AAA. After mobilization, an upper-middle incision of 15 cm was made, and the pancreas head was excised and removed.