title: Splenic vein-inferior mesenteric vein anastomosis to lessen left-sided portal hypertension after pancreaticoduodenectomy with concomitant vascular resection.
abstract: OBJECTIVE
  A splenic vein (SV)-inferior mesenteric vein (IMV) anastomosis reduces congestion of the stomach and spleen after pancreaticoduodenectomy with resection of the SV-mesenteric vein confluence but carries a risk of left-sided venous hypertension.
  
  
  METHODS
  Comparative retrospective study.
  
  
  METHODS
  Department of Digestive Surgery and Transplantation, University of Strasbourg, Strasbourg, France.
  
  
  METHODS
  From January 1, 2002, to February 28, 2010, 39 patients underwent pancreaticoduodenectomy with resection of the SV-mesenteric vein confluence for pancreatic adenocarcinoma. All patients had a terminoterminal portal vein-superior mesenteric vein anastomosis. The SV blood flow into the portal vein was preserved in 11 patients by reimplantation of the SV into the portal vein. Sixteen patients underwent surgical reconstruction of the SV-IMV confluence by anastomosis (group 1), and in 12 patients the natural SV-IMV confluence was preserved (group 2).
  
  
  METHODS
  Preoperative and postoperative spleen volume and platelet count.
  
  
  RESULTS
  Demographic characteristics, preoperative tumor staging, pathological outcome, and postoperative complications were comparable in both groups. There was no difference in platelet count between groups 1 and 2 preoperatively (mean [SD], 293.13 [125.37] vs 241.09 [49.12] × 10(3)/μL [to convert to × 10(9)/L, multiply by 1.0], respectively; P = .21) or postoperatively (mean [SD], 231.75 [156.39] vs 164.31 [76.46] × 10(3)/μL, respectively; P = .32). Likewise, no difference was found in the spleen volume preoperatively (mean [SD], 258.96 [179.23] vs 237.31 [122.46] mL, respectively; P = .76) and on postoperative day 15 (mean [SD], 279.08 [158.10] vs 299.12 [153.11] mL, respectively; P = .78).
  
  
  CONCLUSIONS
  Early assessment shows that SV-IMV anastomosis is as feasible and as safe as the preservation of a natural SV-IMV confluence in patients undergoing pancreaticoduodenectomy with vascular resection for pancreatic head adenocarcinoma.
authors.affiliation: Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098 Strasbourg CEDEX, France.
authors.forename: Nélio
authors.initials: N
authors.lastname: Ferreira
authors.forename: Elie
authors.initials: E
authors.lastname: Oussoultzoglou
authors.forename: Pascal
authors.initials: P
authors.lastname: Fuchshuber
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Ntourakis
authors.forename: Masato
authors.initials: M
authors.lastname: Narita
authors.forename: Mudassir
authors.initials: M
authors.lastname: Rather
authors.forename: Edoardo
authors.initials: E
authors.lastname: Rosso
authors.forename: Pietro
authors.initials: P
authors.lastname: Addeo
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaeck
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D006984:Hypertrophy; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D009929:Organ Size / Q000502:physiology; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010976:Platelet Count; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013154:Spleen / Q000473:pathology*; D013162:Splenic Vein / Q000601:surgery*; D014057:Tomography, X-Ray Computed