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. 2022 Aug 26;22(1):398.
doi: 10.1186/s12876-022-02478-5.

Ligation of left gastric vein may cause delayed gastric emptying after pancreatoduodenectomy: a retrospective study

Koichi Kimura  1 , Ryosuke Minagawa  2 , Takuma Izumi  2 , Akihiko Otake  2 , Takehiko Aoyagi  2 , Daisuke Taniguchi  2 , Hiroko Yano  2 , Yuichiro Kajiwara  2 , Kazuhito Minami  2 , Takashi Nishizaki  2
Affiliations

Ligation of left gastric vein may cause delayed gastric emptying after pancreatoduodenectomy: a retrospective study

Koichi Kimura et al. BMC Gastroenterol. .

Abstract

Background: This study aimed to determine which running pattern of the left gastric vein (LGV) is most frequently ligated in subtotal stomach-preserving pancreatoduodenectomy (SSPPD) and how LGV ligation affects delayed gastric emptying (DGE) after SSPPD.

Methods: We retrospectively analysed 105 patients who underwent SSPPD between January 2016 and September 2021. We classified the running pattern of LGV as follows: type 1 runs dorsal to the common hepatic artery (CHA) or splenic artery (SpA) to join the portal vein (PV), type 2 runs dorsal to the CHA or SpA and joins the splenic vein, type 3 runs ventral to the CHA or SpA and joins the PV, and type 4 runs ventral to the CHA or SpA and joins the SpV. Univariate and multivariate analyses were used to identify differences between patients with and without DGE after SSPPD.

Results: Type 1 LGV running pattern was observed in 47 cases (44.8%), type 2 in 23 (21.9%), type 3 in 12 (11.4%), and type 4 in 23 (21.9%). The ligation rate was significantly higher in type 3 (75.0%) LGVs (p < 0.0001). Preoperative obstructive jaundice (p = 0.0306), LGV ligation (p < 0.0001), grade B or C pancreatic fistula (p = 0.0116), and sepsis (p = 0.0123) were risk factors for DGE in the univariate analysis. Multivariate analysis showed that LGV ligation was an independent risk factor for DGE (odds ratio: 13.60, 95% confidence interval: 3.80-48.68, p < 0.0001).

Conclusion: Type 3 LGVs are often ligated because they impede lymph node dissection; however, LGV preservation may reduce the occurrence of DGE after SSPPD.

Keywords: Obstructive jaundice; Pancreatic fistula; Risk factor; Sepsis; Stomach.

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Conflict of interest statement

The author declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Four running patterns of the left gastric vein. Yellow and green arrowheads point to the left gastric veins. The running patterns indicated by the yellow arrowheads were more frequently ligated than the patterns indicated with green arrowheads. LGV, left gastric vein; CHA, common hepatic artery; SpA, splenic artery; DGA, duodenal gastric artery; PHA, proper hepatic artery; PV, portal vein; SpV, splenic vein; SMV, superior mesenteric vein
Fig. 2
Fig. 2
Mechanism of reducing the development of delayed gastric emptying after subtotal stomach-preserving pancreatoduodenectomy by preserving the left gastric vein as suggested. Double black lines indicate the ligation point. PV, portal vein; SpV, splenic vein; SMV, superior mesenteric vein; GCT, gastrocolic trunk; LGV, left gastric vein; RGV, right gastric vein; SGV, short gastric vein; RGEV, right gastroepiploic vein
See this image and copyright information in PMC

References

    1. Toyama H, Matsumoto I, Mizumoto T, Fujita H, Tsuchida S, Kanbara Y, et al. Influence of the retrocolic versus antecolic route for alimentary tract reconstruction on delayed gastric emptying after pancreatoduodenectomy: a multicenter, noninferiority randomized controlled trial. Ann Surg. 2021;274:935–944. doi: 10.1097/SLA.0000000000004072. - DOI - PubMed
    1. Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220:530–536. doi: 10.1016/j.jamcollsurg.2014.12.031. - DOI - PubMed
    1. Nishizaki T, Ijichi H, Terashi T, Shimabukuro R, Maruyama S, Guntani A, et al. Pancreatogastrostomy with an elastic purse-string suture around the gastric orifice after pancreatoduodenectomy. Surg Today. 2009;39:548–551. doi: 10.1007/s00595-008-3908-2. - DOI - PubMed
    1. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS) Surgery. 2007;142:761–768. doi: 10.1016/j.surg.2007.05.005. - DOI - PubMed
    1. Werba G, Sparks AD, Lin PP, Johnson LB, Vaziri K. The PrEDICT-DGE score as a simple preoperative screening tool identifies patients at increased risk for delayed gastric emptying after pancreaticoduodenectomy. HPB (Oxford) 2022;24:30–39. doi: 10.1016/j.hpb.2021.06.417. - DOI - PubMed

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