Falciform ligament tubular graft for mesenteric‐portal vein reconstruction during pancreaticoduodenectomy 

Abstract

Background Portal vein resection and reconstruction in locally advanced pancreatic cancer represents a potentially curative treatment in selected patients without increasing surgical mortality. However, vascular reconstruction after segmental venous resection is challenging. The parietal peritoneum has emerged as a venous substitute but few reports include its use as a tubular graft. We report a retrospective series of portal vein reconstruction using a falciform ligament tubular graft during pancreaticoduodenectomy. Material and Methods Technical aspects and short‐term morbidity and mortality after pancreaticoduodenectomy with falciform ligament tubular graft interposition were analyzed. Results Among 21 patients who used parietal peritoneum for venous substitution between 2015 and 2019, eight underwent pancreaticoduodenectomy with venous resection and reconstruction using interposition of falciform ligament tubular graft. The mean duration of surgery and clamping time were 350 and 27 min, respectively. No perioperative blood transfusion was required. All the grafts were patent the day after surgery. No complication related to venous obstruction was detected during the hospital stay. Two patients had postoperative pancreatic fistula. No further intervention was needed. The 90‐day mortality was null. Conclusions The use of interposition of falciform ligament tubular graft for portal venous reconstruction during pancreaticoduodenectomy seems to be a reliable, inexpensive, and safe procedure.

How we do it—the use of peritoneal patches for reconstruction of vena cava inferior and portal vein in hepatopancreatobiliary surgery

“…Very recent results, reported by the study group of Balzan et al, showed in a small cohort of 8 patients promising results after application of falciform ligament tubular graft for the reconstruction of PV/VMS during Whipple procedure with vascular resection [ 22 ]. Seven of the 8 patients showed non-altered vascular patency in CT 6 months postoperatively and a partial thrombosis, clinically inapparent, was diagnosed in one patient.…”