Abstract | BACKGROUND: METHODS: RESULTS: Of the 118 patients who underwent pancreatoduodenectomy with porto-mesenterico-splenic confluence resection, 31 (26%) underwent splenic vein reconstruction, 44 patients (37%) developed gastroesophageal varices, and 5 (11%) experienced varix rupture. Sacrifice of all 3 potential collateral veins (what we refer to as the critical veins: left gastric vein, middle colic vein, and superior right colic vein arcade) and absence of any spontaneous splenorenal shunt had a substantial impact on formation of varices. The risk of variceal formation could be stratified based on the number of preserved critical veins, and patent splenic vein reconstruction was associated with a decreased incidence of varices (60% versus 100%, P = .018) among the patients without preservation of the critical veins. In contrast, patients with multiple intact critical veins developed no varices, regardless of splenic vein reconstruction. CONCLUSIONS:
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Authors | Masayuki Tanaka, Hiromichi Ito, Yoshihiro Ono, Kiyoshi Matsueda, Yoshihiro Mise, Takeaki Ishizawa, Yosuke Inoue, Yu Takahashi, Makiko Hiratsuka, Toshiyuki Unno, Akio Saiura |
Journal | Surgery
(Surgery)
Vol. 165
Issue 2
Pg. 291-297
(02 2019)
ISSN: 1532-7361 [Electronic] United States |
PMID | 30268375
(Publication Type: Journal Article)
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Copyright | Copyright © 2018 Elsevier Ltd. All rights reserved. |
Topics |
- Adenocarcinoma
(surgery)
- Adult
- Aged
- Aged, 80 and over
- Blood Loss, Surgical
- Cohort Studies
- Esophageal and Gastric Varices
(etiology, surgery)
- Female
- Humans
- Hypertension, Portal
(etiology)
- Ligation
- Male
- Middle Aged
- Pancreatic Neoplasms
(surgery)
- Pancreaticoduodenectomy
(adverse effects)
- Portal Vein
(surgery)
- Risk Factors
- Splenic Vein
(surgery)
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