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. 2015 Sep;17(9):824-31.
doi: 10.1111/hpb.12463. Epub 2015 Jul 30.

Pancreatectomy with vein reconstruction: technique matters

Monica M Dua  1 , Thuy B Tran  1 , Jill Klausner  2 , Kim J Hwa  1 , George A Poultsides  1 , Jeffrey A Norton  1 , Brendan C Visser  1
Affiliations

Pancreatectomy with vein reconstruction: technique matters

Monica M Dua et al. HPB (Oxford). 2015 Sep.

Abstract

Background: A variety of techniques have been described for portal vein (PV) and/or superior mesenteric vein (SMV) resection/reconstruction during a pancreatectomy. The ideal strategy remains unclear.

Methods: Patients who underwent PV/SMV resection/reconstruction during a pancreatectomy from 2005 to 2014 were identified. Medical records and imaging were retrospectively reviewed for operative details and outcomes, with particular emphasis on patency.

Results: Ninety patients underwent vein resection/reconstruction with one of five techniques: (i) longitudinal venorrhaphy (LV, n = 17); (ii) transverse venorrhaphy (TV, n = 9); (iii) primary end-to-end (n = 28); (iv) patch venoplasty (PV, n = 17); and (v) interposition graft (IG, n = 19). With a median follow-up of 316 days, thrombosis was observed in 16/90 (18%). The rate of thrombosis varied according to technique. All patients with primary end-to-end or TV remained patent. LV, PV and IG were all associated with significant rates of thrombosis (P = 0.001 versus no thrombosis). Comparing thrombosed to patent, there were no differences with respect to pancreatectomy type, pre-operative knowledge of vein involvement and neoadjuvant therapy. Prophylactic aspirin was used in 69% of the total cohort (66% of patent, 81% of thrombosed) and showed no protective benefit.

Conclusions: Primary end-to-end and TV have superior patency than the alternatives after PV/SMV resection and should be the preferred techniques for short (<3 cm) reconstructions.

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Figures

Figure 1
Figure 1
Technical illustrations of before and after images of a longitudinal venorrhaphy performed via Statisnksy clamp (a, b), via a TA 30 stapler (c, d), and transverse venorrhaphy (e, f). Note that the transverse venorrhapy is the least likely to compromise the vein lumen diameter
Figure 2
Figure 2
Technical illustrations of venous reconstruction for shorter segmental resections with primary end-to-end closure with (a) or without (b) splenic vein preservation. PV, portal vein; SMV, superior mesenteric vein; SV, splenic vein
Figure 3
Figure 3
Technical illustration of venous reconstructions for longer segmental resections using a patch (a) or interposition graft conduit such as the internal jugular vein (IJV) (b) or a renal vein graft (c). PV, portal vein; SMV, superior mesenteric vein; SV, splenic vein
Figure 4
Figure 4
Patency of venous reconstructions
See this image and copyright information in PMC

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