• Arch Surg · Dec 2011

    Comparative Study

    Splenic vein-inferior mesenteric vein anastomosis to lessen left-sided portal hypertension after pancreaticoduodenectomy with concomitant vascular resection.

    • Nélio Ferreira, Elie Oussoultzoglou, Pascal Fuchshuber, Dimitrios Ntourakis, Masato Narita, Mudassir Rather, Edoardo Rosso, Pietro Addeo, Patrick Pessaux, Daniel Jaeck, and Philippe Bachellier.
    • Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098 Strasbourg CEDEX, France.
    • Arch Surg. 2011 Dec 1; 146 (12): 1375-81.

    HypothesisA splenic vein (SV)-inferior mesenteric vein (IMV) anastomosis reduces congestion of the stomach and spleen after pancreaticoduodenectomy with resection of the SV-mesenteric vein confluence but carries a risk of left-sided venous hypertension.DesignComparative retrospective study.SettingDepartment of Digestive Surgery and Transplantation, University of Strasbourg, Strasbourg, France.PatientsFrom January 1, 2002, to February 28, 2010, 39 patients underwent pancreaticoduodenectomy with resection of the SV-mesenteric vein confluence for pancreatic adenocarcinoma. All patients had a terminoterminal portal vein-superior mesenteric vein anastomosis. The SV blood flow into the portal vein was preserved in 11 patients by reimplantation of the SV into the portal vein. Sixteen patients underwent surgical reconstruction of the SV-IMV confluence by anastomosis (group 1), and in 12 patients the natural SV-IMV confluence was preserved (group 2).Main Outcome MeasuresPreoperative and postoperative spleen volume and platelet count.ResultsDemographic characteristics, preoperative tumor staging, pathological outcome, and postoperative complications were comparable in both groups. There was no difference in platelet count between groups 1 and 2 preoperatively (mean [SD], 293.13 [125.37] vs 241.09 [49.12] × 10(3)/μL [to convert to × 10(9)/L, multiply by 1.0], respectively; P = .21) or postoperatively (mean [SD], 231.75 [156.39] vs 164.31 [76.46] × 10(3)/μL, respectively; P = .32). Likewise, no difference was found in the spleen volume preoperatively (mean [SD], 258.96 [179.23] vs 237.31 [122.46] mL, respectively; P = .76) and on postoperative day 15 (mean [SD], 279.08 [158.10] vs 299.12 [153.11] mL, respectively; P = .78).ConclusionEarly assessment shows that SV-IMV anastomosis is as feasible and as safe as the preservation of a natural SV-IMV confluence in patients undergoing pancreaticoduodenectomy with vascular resection for pancreatic head adenocarcinoma.

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