Table 1 Avoiding hemorrhage during pancreaticoduodenectomy checklist

1. Complete preoperative cross-sectional imaging is essential

2. Thoughtful preoperative resectional planning avoids hemorrhage

3. Do not proceed to the next step until the current one is hemostatic

4. Left handed compression in the context of a complete Kocherization is crucial

5. Widen the approach/exposure to the SMV/PV at the borders of the pancreas

6. Allis clamps never met veins they didn’t like

7. Leave the GDA stump as long as is technically possible

8. Direct palpation and visualization of the SMA minimizes the risk of injury

9. Harvest reconstruction conduit prior to the vascular resection

10. Stay calm and obtain experienced assistance when hemorrhage is significant

11. Possess a progressive hierarchy of techniques to arrest haemorrhage

12. Principles are consistent for both open and minimally invasive approaches