Safi Dokmak1, Béatrice Aussilhou2, Alain Sauvanet2, Philippe Lévy3, Aurélie Plessier4, Fadhel S Ftériche2, Olivier Farges2, Valérie Vilgrain5, Dominique C Valla4, Jacques Belghiti2. 1. Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France. Electronic address: safi.dokmak@bjn.aphp.fr. 2. Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France. 3. Department of Gastroenterology and Pancreatic Diseases, Beaujon Hospital, Clichy, France. 4. Department of Hepatology, Beaujon Hospital, Clichy, France. 5. Department of Radiology, Beaujon Hospital, Clichy, France.
Abstract
BACKGROUND: Supra-mesocolic surgery (SMS) is complicated in patients with portal vein cavernoma (PC) and portal decompression is recommended. The aim of this study was to report a large single centre of SMS in patients with PC without portal decompression. METHODS: Between 2006 and 2013, all patients who met inclusion criteria were analyzed retrospectively. The primary endpoint was the feasibility rate, surgical and postoperative outcome. The secondary endpoints were the long-term outcome of patients who underwent biliary bypass for cholangitis. Risk factors for complications were studied. RESULTS: Thirty patients underwent 51 procedures. Pancreatitis was the main etiology of PC (19/30) and biliary obstruction was mainly related to the underlying disease and not to portal cholangiopathy (12/14). All planned procedures were successfully completed. Fourteen patients underwent biliary bypass. Median blood loss (250 ml), transfusion (n = 7), mortality (n = 0), overall morbidity (n = 12) and the median hospital stay (10 days). Good long-term control of cholangitis was achieved in the 9 patients alive with available follow-up. Significant risk factors for complications were a previous abdominal wall scar, previous intra-abdominal surgical field and liver fibrosis. CONCLUSION: SMS can be safely performed in patients with PC. In patients with risk factors for complications, portal decompression should be discussed.
BACKGROUND: Supra-mesocolic surgery (SMS) is complicated in patients with portal vein cavernoma (PC) and portal decompression is recommended. The aim of this study was to report a large single centre of SMS in patients with PC without portal decompression. METHODS: Between 2006 and 2013, all patients who met inclusion criteria were analyzed retrospectively. The primary endpoint was the feasibility rate, surgical and postoperative outcome. The secondary endpoints were the long-term outcome of patients who underwent biliary bypass for cholangitis. Risk factors for complications were studied. RESULTS: Thirty patients underwent 51 procedures. Pancreatitis was the main etiology of PC (19/30) and biliary obstruction was mainly related to the underlying disease and not to portal cholangiopathy (12/14). All planned procedures were successfully completed. Fourteen patients underwent biliary bypass. Median blood loss (250 ml), transfusion (n = 7), mortality (n = 0), overall morbidity (n = 12) and the median hospital stay (10 days). Good long-term control of cholangitis was achieved in the 9 patients alive with available follow-up. Significant risk factors for complications were a previous abdominal wall scar, previous intra-abdominal surgical field and liver fibrosis. CONCLUSION:SMS can be safely performed in patients with PC. In patients with risk factors for complications, portal decompression should be discussed.
Authors: Eric Vibert; Daniel Azoulay; Thomas Aloia; Gérard Pascal; Luc-Antoine Veilhan; René Adam; Didier Samuel; Denis Castaing Journal: Ann Surg Date: 2007-07 Impact factor: 12.969
Authors: Y Bayraktar; F Balkanci; A Ozenc; S Arslan; T Koseoglu; A Ozdemir; B Uzunalimoglu; H Telatar; A Gurakar; D H Van Thiel Journal: Am J Gastroenterol Date: 1995-11 Impact factor: 10.864