Total pancreatectomy with intraportal auto-islet transplantation using a temporarily exteriorized omental vein

Islet autotransplantation: past, present and future. Chapter II: the role of islet autotransplantation for the treatment of chronic pancreatitis

“…Kobayashi et al reported that purification with COBE 2991 Cell Processor (Cobe BCT, CO, USA) was performed whenever the digest volume exceeded 20 ml, with the average tissue obtained for intraportal infusion of 13.2 ± 10.2 ml [31]. There have been reports where part of the islet preparation was placed in an alternate site, such as sub-mucosal layer of the stomach and peritoneal cavity, when portal pressure during the islet infusion reached 20-30 cm of water [30,33]. Correction of the tissue volume for patient's body weight was found to significantly improve the predictive ability of the model of portal hypertension based on tissue volume [30,33].…”

“…There have been reports where part of the islet preparation was placed in an alternate site, such as sub-mucosal layer of the stomach and peritoneal cavity, when portal pressure during the islet infusion reached 20-30 cm of water [30,33]. Correction of the tissue volume for patient's body weight was found to significantly improve the predictive ability of the model of portal hypertension based on tissue volume [30,33]. However, due to the fact that in IAT, there is no possibility of selecting a donor for favorable BMI, age and underlying disease prior to the surgical manipulation of the pancreas, the decision as to whether or not to purify a given islet preparation should rest with the surgeon and the isolation team.…”

Total Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis

“…However, techniques also exist for intraportal embolizaiont of islet so the liver after abdominal closure has been obtained. The techniques include emoblization to a temporarily exteriorized omental vein (Nath et al, 2004); via a recanalized umbilical vein (Pollard et al, 2011) or percutaneous transhepatic access to the portal vein for infusion of the islets (Morgan et al, 2011). The latter approach frees up surgeons and an operating room for other procedures sooner than if the islets are infused in the operating room and thus is thought to be cost-effective at least at one center (Morgan et al, 2011), but the expense incurred by using interventional radiology must also be considered as well as the fact that the abdomen cannot be inspected for bleeding after the heparinization and increased portal pressure that ensue by lieu of the infusion (Blondet et al, 2007).…”

Use of the Recanalised Umbilical Vein for Islet Autotransplantation following Total Pancreatectomy

“…A different method involves the use of a large omental vein which is then exteriorised through the abdominal wall by creating an omental tongue fashioned as a pedicle around the vein which is used. This allows access to the portal vein in the postoperative period and is useful if further infusions are required [6]. …”