{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T05:02:51Z","timestamp":1779771771433,"version":"3.53.1"},"reference-count":36,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background\/Purpose<\/jats:title>\n                    <jats:p>Chyle leakage (CL) after pancreaticoduodenectomy (PD) remains an underestimated complication with a consistent incidence. This expert survey analyzed its occurrence from anatomical and surgical perspectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A structured survey was distributed to 57 surgeons from 10 countries, with extensive experience in open and minimally\u2010invasive pancreatectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most experts reported CL incidence as: open\u2009\u2265\u2009laparoscopic, open\u2009&gt;\u2009robotic, and laparoscopic\u2009=\u2009robotic. They identified three major anatomical pitfalls: (i) the transverse mesocolon on the ventral side of the superior mesenteric artery and vein (SMA\/SMV), (ii) the meso\u2010jejunum on the dorsal side of the SMA\/SMV, and (iii) the fusion fascia of Treitz on the ventral side of the inferior vena cava (IVC). For lymphatic dissection and control, energy devices were favored across all approaches, whereas ligation was more common in open PD and clipping more frequent in robotic PD. Opinions on the optimal dissection plane at the fusion fascia of Treitz varied: along the pancreatic surface (21%), within the fascia (31%), or exposing the IVC (38%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Expert opinions suggest that the incidence of CL after PD does not differ significantly between open and minimally invasive approaches. Consensus emerged regarding common anatomical pitfalls, which may inform strategies for prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhbp.70135","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T04:16:33Z","timestamp":1779768993000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expert Survey on Chyle Leakage After Pancreaticoduodenectomy: The Precision Anatomy for Minimally Invasive Hepato\u2010Biliary\u2010Pancreatic Surgery (\n                    <scp>PAM<\/scp>\n                    \u2010\n                    <scp>HBP<\/scp>\n                    Surgery) Project 2024"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3785-7502","authenticated-orcid":false,"given":"Hitoe","family":"Nishino","sequence":"first","affiliation":[{"name":"Department of General Surgery, Graduate School of Medicine Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7315-0830","authenticated-orcid":false,"given":"Atsushi","family":"Oba","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3792-5659","authenticated-orcid":false,"given":"Keiichi","family":"Akahoshi","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery Institute of Science Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5074-0205","authenticated-orcid":false,"given":"Taiga","family":"Wakabayashi","sequence":"additional","affiliation":[{"name":"Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases Ageo Central General Hospital  Saitama 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A Proposal for the Term \u201cP\u2010A Ligament\u201d Based on Anatomical Findings","volume":"96","author":"Muro S.","year":"2021","journal-title":"Anatomical Science International"},{"issue":"5","key":"e_1_2_10_31_1","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1007\/s11605-020-04619-1","article-title":"Optimal Lymphadenectomy of the Mesopancreas Based on Fluorescence Imaging During Pancreaticoduodenectomy","volume":"25","author":"Matsuki R.","year":"2021","journal-title":"Journal of Gastrointestinal Surgery"},{"issue":"4","key":"e_1_2_10_32_1","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1002\/bjs.9013","article-title":"Chylous Ascites After Hepatopancreatobiliary Surgery","volume":"100","author":"Kuboki S.","year":"2013","journal-title":"British Journal of Surgery"},{"issue":"4","key":"e_1_2_10_33_1","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1007\/s00268-016-3772-y","article-title":"Chylous Ascites Management After Pancreatic Surgery","volume":"41","author":"Tabchouri N.","year":"2017","journal-title":"World Journal of Surgery"},{"issue":"1","key":"e_1_2_10_34_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/joa.14036","article-title":"Retroperitoneal Fasciae as Barriers for Nerve and Arterial Passages Connecting the Retroperitoneal Region to the Peritoneal Organs","volume":"245","author":"Sugiyama Y.","year":"2024","journal-title":"Journal of Anatomy"},{"key":"e_1_2_10_35_1","first-page":"113","article-title":"Uber einem neure Muskel am Duodenum des Menschen, uber elastische Sehnen, und einige andere anatomische Verhaltnisse Virteljahr prakt","volume":"37","author":"Treitz W.","year":"1853","journal-title":"Heilkunde"},{"issue":"6","key":"e_1_2_10_36_1","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1007\/s00534-009-0126-2","article-title":"An Investigation of the Embryologic Development of the Fascia Used as the Basis for Pancreaticoduodenal Mobilization","volume":"16","author":"Cho B. 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