RT Journal
A1 Ferreira N, Oussoultzoglou E, Fuchshuber P, et al
T1 SPlenic vein–inferior mesenteric vein anastomosis to lessen left-sided portal hypertension after pancreaticoduodenectomy with concomitant vascular resection
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD December 1
VO 146
IS 12
SP 1375
OP 1381
DO 10.1001/archsurg.2011.688
UL http://dx.doi.org/10.1001/archsurg.2011.688
AB Hypothesis 
                  A 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.Design 
                  Comparative retrospective study.Setting 
                  Department of Digestive Surgery and Transplantation, University of Strasbourg, Strasbourg, France.Patients 
                  From 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 Measures 
                  Preoperative and postoperative spleen volume and platelet count.Results 
                  Demographic 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] × 103/μL [to convert to ×109/L, multiply by 1.0], respectively; P = .21) or postoperatively (mean [SD], 231.75 [156.39] vs 164.31 [76.46] × 103/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).Conclusion 
                  Early 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.