title: Safety of supramesocolic surgery in patients with portal cavernoma without portal vein decompression. Large single centre experience.
abstract: Supra-mesocolic surgery (SMS) is complicated in patients with portal vein cavernoma (PC) and portal decompression is recommended. The aim of this study was to report a large single centre of SMS in patients with PC without portal decompression.
  
  
  
  Between 2006 and 2013, all patients who met inclusion criteria were analyzed retrospectively. The primary endpoint was the feasibility rate, surgical and postoperative outcome. The secondary endpoints were the long-term outcome of patients who underwent biliary bypass for cholangitis. Risk factors for complications were studied.
  
  
  
  Thirty patients underwent 51 procedures. Pancreatitis was the main etiology of PC (19/30) and biliary obstruction was mainly related to the underlying disease and not to portal cholangiopathy (12/14). All planned procedures were successfully completed. Fourteen patients underwent biliary bypass. Median blood loss (250 ml), transfusion (n = 7), mortality (n = 0), overall morbidity (n = 12) and the median hospital stay (10 days). Good long-term control of cholangitis was achieved in the 9 patients alive with available follow-up. Significant risk factors for complications were a previous abdominal wall scar, previous intra-abdominal surgical field and liver fibrosis.
  
  
  
  SMS can be safely performed in patients with PC. In patients with risk factors for complications, portal decompression should be discussed.
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France. Electronic address: safi.dokmak@bjn.aphp.fr.
authors.forename: Safi
authors.initials: S
authors.lastname: Dokmak
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Aussilhou
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.affiliation: Department of Gastroenterology and Pancreatic Diseases, Beaujon Hospital, Clichy, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lévy
authors.affiliation: Department of Hepatology, Beaujon Hospital, Clichy, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Plessier
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
authors.forename: Fadhel S
authors.initials: FS
authors.lastname: Ftériche
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Farges
authors.affiliation: Department of Radiology, Beaujon Hospital, Clichy, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Vilgrain
authors.affiliation: Department of Hepatology, Beaujon Hospital, Clichy, France.
authors.forename: Dominique C
authors.initials: DC
authors.lastname: Valla
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
mesh_terms: D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion / Q000009:adverse effects; D002763:Cholecystectomy / Q000009:adverse effects; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003097:Collateral Circulation; D000072226:Computed Tomography Angiography; D019299:Decompression, Surgical; D004322:Drainage / Q000295:instrumentation; D005260:Female; D005602:France; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D017082:Portal Pressure; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome