Xiazhen Yu1,2,3, Xueli Bai1,2,3, Qinghai Li4, Shunliang Gao1,2,3, Jianying Lou5, Risheng Que1,2,3, Dipesh Kumar Yadav1,2,3, Yun Zhang1,2,3, Haijun Li6, Tingbo Liang7,8,9. 1. Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China. 2. Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China. 3. Innovation Center for the Study of Pancreatic Diseases, Hangzhou, Zhejiang Province, China. 4. Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. 5. Department of Hepatobiliary and Pancreatic Surgery, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China. 6. Department of General Surgery, Shenzhen Luohu People's Hospital, Shenzhen, Guangdong, China. 7. Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China. liangtingbo@zju.edu.cn. 8. Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China. liangtingbo@zju.edu.cn. 9. Innovation Center for the Study of Pancreatic Diseases, Hangzhou, Zhejiang Province, China. liangtingbo@zju.edu.cn.
Abstract
BACKGROUND: The ligation of the splenic vein (SV) during pancreaticoduodenectomy (PD) may result in sinistral portal hypertension (SPH). This study aimed to identify the collateral pathways that formed postoperatively and evaluate the impact of omentum and arc of Barkow preservation in PD. METHODS: Patients who underwent PD between January 2013 and May 2018 at the Second Affiliated Hospital of Zhejiang University were enrolled in this retrospective study. PD was performed with preservation of the greater omentum and arc of Barkow. Venous collaterals, spleen size, and platelet count were evaluated before and after surgery. RESULTS: In total, 330 patients underwent PD, of whom, 43 patients who underwent superior mesenteric vein (SMV)/portal vein (PV) reconstruction and splenic vein (SV) ligation were selected. No patient developed severe gastrointestinal bleeding. Three collateral routes were identified: the left gastric route, the colic marginal route, and the first jejunal route. Seventeen patients developed splenomegaly. Twenty-three patients developed thrombocytopenia. However, none of them developed gastrointestinal bleeding or other clinical complaints. CONCLUSION: Although subclinical SPH developed after SV ligation, postoperative gastrointestinal bleeding was uncommon.
BACKGROUND: The ligation of the splenic vein (SV) during pancreaticoduodenectomy (PD) may result in sinistral portal hypertension (SPH). This study aimed to identify the collateral pathways that formed postoperatively and evaluate the impact of omentum and arc of Barkow preservation in PD. METHODS:Patients who underwent PD between January 2013 and May 2018 at the Second Affiliated Hospital of Zhejiang University were enrolled in this retrospective study. PD was performed with preservation of the greater omentum and arc of Barkow. Venous collaterals, spleen size, and platelet count were evaluated before and after surgery. RESULTS: In total, 330 patients underwent PD, of whom, 43 patients who underwent superior mesenteric vein (SMV)/portal vein (PV) reconstruction and splenic vein (SV) ligation were selected. No patient developed severe gastrointestinal bleeding. Three collateral routes were identified: the left gastric route, the colic marginal route, and the first jejunal route. Seventeen patients developed splenomegaly. Twenty-three patients developed thrombocytopenia. However, none of them developed gastrointestinal bleeding or other clinical complaints. CONCLUSION: Although subclinical SPH developed after SV ligation, postoperative gastrointestinal bleeding was uncommon.