title: Parietal Peritoneum as an Autologous Substitute for Venous Reconstruction in Hepatopancreatobiliary Surgery.
abstract: OBJECTIVE
  To evaluate the parietal peritoneum (PP) as an autologous substitute for venous reconstruction during hepatopancreatobiliary (HPB) surgery.
  
  
  BACKGROUND
  Venous resection during liver or pancreatic resection may require a rapidly available substitute especially when the need for venous resection is unforeseen.
  
  
  METHODS
  The PP was used as an autologous substitute during complex liver and pancreatic resections. Postoperative anticoagulation was standard and venous patency was assessed by routine computed tomographic scans.
  
  
  RESULTS
  Thirty patients underwent vascular resection during pancreatic (n = 18) or liver (n = 12) resection, mainly for malignant tumors (n = 29). Venous resection was an emergency procedure in 4 patients due to prolonged vascular occlusion. The PP, with a mean length of 22 mm (15-70), was quickly harvested and used as a lateral (n = 28) or a tubular (n = 2) substitute for reconstruction of the mesentericoportal vein (n = 24), vena cava (n = 3), or hepatic vein (n = 3). Severe morbidity included Clavien grade-III complications in 4 (13%) patients but there was no PP-related or hemorrhagic complications. Histological vascular invasion was present in 18 (62%) patients, and all had an R0 resection (100%). After a mean follow-up of 14 (7-33) months, all venous reconstructions were patent except for 1 tubular graft (97%).
  
  
  CONCLUSIONS
  A PP can be safely used as a lateral patch for venous reconstruction during HPB surgery; this could help reduce reluctance to perform vascular resection when oncologically required. Clinical trials identification: NCT02121886.
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
authors.forename: Safi
authors.initials: S
authors.lastname: Dokmak
authors.forename: Béatrice
authors.initials: B
authors.lastname: Aussilhou
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.forename: Ganesh
authors.initials: G
authors.lastname: Nagarajan
authors.forename: Olivier
authors.initials: O
authors.lastname: Farges
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D010537:Peritoneum / Q000637:transplantation*; D011169:Portal Vein / Q000601:surgery*; D016896:Treatment Outcome; D014684:Venae Cavae / Q000601:surgery*