Pancreatic head resection for chronic pancreatitis in patients with extrahepatic generalized portal hypertension.
BACKGROUND
Five percent to 10% of chronic pancreatitis (CP) cases are complicated by portal venous occlusion leading to extrahepatic generalized portal hypertension (GPH). Pancreatic head resections (PHR) are regarded risky or contraindicated in patients with extrahepatic GPH. The aim of our study was to analyze the outcome of patients with extrahepatic GPH undergoing PHR for CP and to propose recommendations for surgical strategy.


METHODS
Sixteen of 185 patients with PHR suffered from extrahepatic GPH. Perioperative and follow-up data were documented prospectively and analyzed to assess the outcome.


RESULTS
Preoperative interventional thrombolysis of the portal vein was successfully performed in 5 patients and alleviated further PHR. Median operative time and blood transfusions were higher in patients with extrahepatic GPH compared with patients without extrahepatic GPH (P<.01). Overall complication rate was not statistically different (44% vs 34%). One death occurred in each group. At the end of follow-up (median, 18 months) 13 of 15 patients with extrahepatic GPH were free of pain. No variceal bleeding or cholestasis was documented. All patients judged their status as subjectively improved.


CONCLUSIONS
Although technically demanding in the presence of extrahepatic GPH, PHR can be performed with an acceptable morbidity and mortality in an experienced center. Preoperative interventional recanalization of portal vein thrombosis may render PHR possible by restoring normal splanchnic blood flow in selected cases indicated for surgery.
Adam
Ulrich
U
Departments of Surgery and Radiology, the University Hospital of Freiburg, Hugstetterstrasse 55, D-79106 Freiburg, Germany.
Makowiec
Frank
F
Riediger
Hartwig
H
Keck
Tobias
T
Kröger
Jens C
JC
Uhrmeister
Peter
P
Hopt
Ulrich T
UT
D000328:Adult; D000368:Aged; D000792:Angiography; D002908:Chronic Disease; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000628:therapy*; D008297:Male; D008642:Mesenteric Veins; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010195:Pancreatitis / Q000150:complications / Q000601:surgery*; D011169:Portal Vein; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000628:therapy*
D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator