Safi Dokmak1, Béatrice Aussilhou2, Mélanie Calmels2, Houcine Maghrebi3, Fadhel Samir Ftériche2,3, Olivier Soubrane2, Alain Sauvanet2. 1. Department of HPB Surgery and Liver Transplantation, Beaujon Hopsital, Assistance Publique Hôpitaux de Paris, University Paris VII, Clichy, France. safi.dokmak@bjn.aphp.fr. 2. Department of HPB Surgery and Liver Transplantation, Beaujon Hopsital, Assistance Publique Hôpitaux de Paris, University Paris VII, Clichy, France. 3. Department of Digestive Surgery, La Rabta Hospital, Tunis, Tunisia.
Abstract
BACKGROUND: With the improvement of the surgical technique of Laparoscopic pancreaticoduodenectomy (LPD), indications will be extended to patients with vascular invasion. With LPD, vascular grafts for reconstruction are more frequently needed because adequate mobilization is not always done and vascular grafts can safely facilitate reconstruction. We describe our experience of reconstruction with the falciform ligament. METHODS: Venous reconstruction is performed after removal of the specimen. The falciform ligament is rapidly harvested within the same surgical field and for any size and used for lateral reconstruction of the mesentericoportal vein. Therapeutic anticoagulation is not needed and venous patency was assessed by postoperative CT scan. Since April 2011 and among the 93 patients who underwent LPD, four patients had this procedure. RESULTS: The mean age was 73 years old (69-77) and 3 were women. Indications for resection were pancreatic adenocarcinoma (n = 3) and IPMN in severe dysplasia (n = 1) and the mean patch size of 13 mm (10-30). The mean operative time was 397 min (330-480); vascular clamping lasted 54 min (45-60), and mean blood loss was 437 ml (150-1000) and one was transfused. Resection was R0 in patients with adenocarcinoma (n = 3). The postoperative course was uneventful in 3 patients and one patient was re-operated for bile leak and partial venous thrombosis and redo venous reconstruction was done. Complete venous patency was demonstrated in patients (n = 2) who still alive 1 year after resection. CONCLUSION: Venous resection will be more frequently done with LPD and vascular grafts more frequently needed. Compared to other available vascular grafts (autogenous, synthetic, cadaveric and bovine pericardium, etc), the parietal peritoneum had the advantages of being rapidly available, easy to harvest by the laparoscopic approach, not expensive, no need for anticoagulation and at lower risk of infection.
BACKGROUND: With the improvement of the surgical technique of Laparoscopic pancreaticoduodenectomy (LPD), indications will be extended to patients with vascular invasion. With LPD, vascular grafts for reconstruction are more frequently needed because adequate mobilization is not always done and vascular grafts can safely facilitate reconstruction. We describe our experience of reconstruction with the falciform ligament. METHODS: Venous reconstruction is performed after removal of the specimen. The falciform ligament is rapidly harvested within the same surgical field and for any size and used for lateral reconstruction of the mesentericoportal vein. Therapeutic anticoagulation is not needed and venous patency was assessed by postoperative CT scan. Since April 2011 and among the 93 patients who underwent LPD, four patients had this procedure. RESULTS: The mean age was 73 years old (69-77) and 3 were women. Indications for resection were pancreatic adenocarcinoma (n = 3) and IPMN in severe dysplasia (n = 1) and the mean patch size of 13 mm (10-30). The mean operative time was 397 min (330-480); vascular clamping lasted 54 min (45-60), and mean blood loss was 437 ml (150-1000) and one was transfused. Resection was R0 in patients with adenocarcinoma (n = 3). The postoperative course was uneventful in 3 patients and one patient was re-operated for bile leak and partial venous thrombosis and redo venous reconstruction was done. Complete venous patency was demonstrated in patients (n = 2) who still alive 1 year after resection. CONCLUSION: Venous resection will be more frequently done with LPD and vascular grafts more frequently needed. Compared to other available vascular grafts (autogenous, synthetic, cadaveric and bovine pericardium, etc), the parietal peritoneum had the advantages of being rapidly available, easy to harvest by the laparoscopic approach, not expensive, no need for anticoagulation and at lower risk of infection.
Authors: Paul J Speicher; Daniel P Nussbaum; Rebekah R White; Sabino Zani; Paul J Mosca; Dan G Blazer; Bryan M Clary; Theodore N Pappas; Douglas S Tyler; Alexander Perez Journal: Ann Surg Oncol Date: 2014-06-13 Impact factor: 5.344
Authors: A Cekirdekci; M K Bayar; S Yilmaz; M Cihangiroglu; E Ayan; M Duran; T Bakalim; D Kaya; O Gokce Journal: Eur J Vasc Endovasc Surg Date: 2004-01 Impact factor: 7.069
Authors: U Boggi; S Signori; N De Lio; V G Perrone; F Vistoli; M Belluomini; C Cappelli; G Amorese; F Mosca Journal: Br J Surg Date: 2013-06 Impact factor: 6.939