The left splenorenal venous shunt decreases clinical signs of sinistral portal hypertension associated with splenic vein ligation during pancreaticoduodenectomy with venous resection

Addeo, Pietro; Mathelin, Pierre de; Avérous, Gerlinde; Tambou-Nguipi, Marlene; Terrone, Alfonso; Schaaf, Caroline; Dufour, Patrick; Bachellier, Philippe

doi:10.1016/j.surg.2020.04.033

Cited by 17 publications

(16 citation statements)

References 29 publications

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“…It has been shown that the patients undergoing additional gastric resection faced with significantly deteriorated postoperative nutritional status and quality of life [31]. Therefore, surgical reconstructive venous drainage of the gastric and splenic vein may provide an alternative to avoid venous congestion and additional gastrectomy [18,32].…”

Section: Discussionmentioning

confidence: 99%

“…The distal splenorenal shunt (SRS) is one option of a portosystemic shunt that allows gastric and splenic venous drainage via the left renal vein into the systemic circulation [15][16][17]. Recently, it has been shown that performing SRS during pancreatoduodenectomy may reduce postoperative severe complications, such as left-sided portal hypertension [17,18]. In the same time period, the procedure has been developed and implemented in our center for patients with signs of venous congestion after portal venous resection.…”

Section: Introductionmentioning

confidence: 99%

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Splenorenal shunt for reconstruction of the gastric and splenic venous drainage during pancreatoduodenectomy with resection of the portal venous confluence

Al-Saeedi

Frank-Moldzio

Contin

et al. 2021

Langenbecks Arch Surg

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Background Resection of the portal venous confluence is frequently necessary for radical resection during pancreatoduodenectomy for cancer. However, ligation of the splenic vein can cause serious postoperative complications such as gastric/splenic venous congestion and left-sided portal hypertension. A splenorenal shunt (SRS) can maintain gastric and splenic venous drainage and mitigate these complications. Purpose This study describes the surgical technique, postoperative course, and surgical outcomes of SRS after pancreatoduodenectomy. Methods Ten patients who underwent pancreatoduodenectomy and SRS between September 2017 and April 2019 were evaluated. After resection an end-to-side anastomosis between the splenic vein and the left renal vein was performed. Postoperative shunt patency, splenic volume, and any SRS-related complications were recorded. Results The rates of short- and long-term shunt patency were 100% and 60%, respectively. No procedure-associated complications were observed. No signs of left-sided portal hypertension, such as gastrointestinal bleeding or splenomegaly, and no gastric/splenic ischemia were observed in patients after SRS. Conclusion SRS is a safe and effective measure to mitigate gastric congestion and left-sided portal hypertension after pancreatoduodenectomy with compromised gastric venous drainage after resection of the portal venous confluence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Splenorenal shunt for reconstruction of the gastric and splenic venous drainage during pancreatoduodenectomy with resection of the portal venous confluence

Al-Saeedi

Frank-Moldzio

Contin

et al. 2021

Langenbecks Arch Surg

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“…As expected, cases included in the first group reported a significantly longer overall median survival time (18 months) when compared to cases included in the fourth group (in which the overall median survival time was only 10 months) (14). When it comes to the necessity of splenic vein reimplantation, different points of view have been proposed so far; therefore, while certain authors consider that after extended venous resections the splenic vein can be safely ligated, an adequate collateral circulation being expected, others consider that the risk of splenic infraction or gastric varices development is too high and therefore, they recommend to avoid this maneuver and to re-anastomose it at the level of the graft (20)(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Superior Mesenteric Vein Resection Followed by Porto-Jejunal Anastomosis During Pancreatoduodenectomy for Borderline Resectable Pancreatic Cancer – A Case Report and Literature Review

Bacalbaşa

Bălescu

Varlas

et al. 2021

In Vivo

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Background/Aim: Pancreatic cancer represents the most lethal abdominal malignancy, the only chance for achieving an improvement in terms of survival being represented by radical surgery. Although it has been considered that venous invasion represents a contraindication for resection, recently it has been demonstrated that in regards to overall survival after radical resection, it is similar to the one reported after standard pancreatoduodenectomy. Case Report: A 53year-old patient with no significant medical past was diagnosed with a borderline resectable pancreatic adenocarcinoma invading the superior mesenteric vein. The patient was submitted to pancreatoduodenectomy en bloc with superior mesenteric vein resection; the two jejunal veins were further anastomosed to the remnant portal vein. The postoperative outcome was favorable; the patient was discharged in the 10 th postoperative day. Conclusion: Although technically more 2975 This article is freely accessible online.

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“…Some studies indicated no gastrointestinal bleeding even after the incidence of varicose formation [ 10 , 14 , 18 , 21 , 26 , 27 , 28 ], but others reported the incidence of severe variceal bleeding [ 4 , 5 , 6 , 7 , 8 , 9 , 11 , 13 , 17 , 19 , 24 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. This difference may be due to the dedicated adjustment of SV pressure by collateral routes from the spleen.…”

Section: Pathogenesis Of Sphmentioning

confidence: 99%

“…Reflecting the increased spleen volume after surgery, the platelet count ratio at 6 months after surgery in the patients after the SV resection was significantly lower than that in patients without the SV resection [ 13 , 16 , 37 ]. This SV pressure could be controlled by increasing collaterals from the spleen, through methods such as SV reconstruction [ 12 , 13 , 14 , 15 , 31 , 38 ] or decreasing the blood inflow to the spleen (splenic artery ligation) [ 16 , 37 ].…”

Section: Pathogenesis Of Sphmentioning

confidence: 99%

Sinistral Portal Hypertension after Pancreaticoduodenectomy with Splenic Vein Resection: Pathogenesis and Its Prevention

Inoue

Kato

et al. 2021

Cancers

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To achieve curative resection for pancreatic cancer during pancreaticoduodenectomy (PD), extensive portal vein (PV) resection, including porto-mesenterico-splenic confluence (PMSC), may sometimes be necessary if the tumor is close to the portal venous system. Recently, this extended resection has been widely accepted in high-volume centers for pancreatic resection due to its favorable outcomes compared with non-operative treatment. However, in patients with long-term survival, sinistral portal hypertension (SPH) occurs as a late-onset postoperative complication. These patients present gastrointestinal varices due to congested venous flow from the spleen, which may cause critical variceal bleeding. Since the prognosis of patients with pancreatic cancer has improved, owing to the development of chemotherapy and surgical techniques, SPH is no longer a negligible matter in the field of pancreatic cancer surgery. This review clarifies the pathogenesis and frequency of SPH after PD through PMSC resection and discusses its prediction and prevention.

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The left splenorenal venous shunt decreases clinical signs of sinistral portal hypertension associated with splenic vein ligation during pancreaticoduodenectomy with venous resection

Cited by 17 publications

References 29 publications

Splenorenal shunt for reconstruction of the gastric and splenic venous drainage during pancreatoduodenectomy with resection of the portal venous confluence

Splenorenal shunt for reconstruction of the gastric and splenic venous drainage during pancreatoduodenectomy with resection of the portal venous confluence

Superior Mesenteric Vein Resection Followed by Porto-Jejunal Anastomosis During Pancreatoduodenectomy for Borderline Resectable Pancreatic Cancer – A Case Report and Literature Review

Sinistral Portal Hypertension after Pancreaticoduodenectomy with Splenic Vein Resection: Pathogenesis and Its Prevention

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