Concomitant splenic artery ligation has no preventive effect on left‐sided portal hypertension following pancreaticoduodenectomy with the resection of the portal and superior mesenteric vein confluence for pancreatic ductal adenocarcinoma. Issue 3 (10th February 2022)

• Record Type: Journal Article
• Authors: Gyoten, Kazuyuki; Mizuno, Shugo; Nagata, Motonori; Ito, Takahiro; Hayasaki, Aoi; Murata, Yasuhiro; Tanemura, Akihiro; Kuriyama, Naohisa; Kishiwada, Masashi; Sakurai, Hiroyuki
• Is Part Of: Annals of gastroenterological surgery. Volume 6:Issue 3(2022)
• Page Start: 420
• Page End: 429
• Publication Date: 2022-02-10
• Subjects: left‐sided portal hypertension -- plenic artery ligation -- splenic vein division -- splenomegaly -- thrombocytopenia -- varices; Digestive organs -- Surgery -- Periodicals; 617.43
• DOI: 10.1002/ags3.12545
• Languages: English
• ISSNs: 2475-0328

Abstract

Abstract: Background: Left‐sided portal hypertension (LSPH) caused by splenic vein (SV) division in pancreaticoduodenectomy (PD) with portal vein (PV) resection remains challenging. The current study aimed to investigate the efficacy of splenic artery (SA) ligation in preventing LSPH. Methods: One‐hundred thirty patients who underwent PD with PV resection for pancreatic ductal adenocarcinoma were classified into SV and SA preservation (SVP, n = 30), SV resection and SA preservation (SVR, n = 59), and SV resection and SA ligation (SAL, n = 41). The postoperative incidence of LSPH was assessed. Results: The incidence of variceal formation in SVP, SVR, and SAL were 4.8%, 53.2%, and 46.4% at 3 mo, 13.0%, 71.2%, and 62.5% at 6 mo, and 25.0%, 87.5%, and 87.1% at 12 mo, respectively. The rate was significantly higher in SVR at 3 and 6 mo ( P = .001 and P < .001, respectively) and in SVR and SAL ( P < .001) at 12 mo. Variceal hemorrhage occurred only in SVR (n = 4). The platelet count ratio at 3, 6, and 12 mo began to significantly decrease from 3 mo in SVR (0.77, 0.67, and 0.60, respectively; P < .001) and 6 mo in SAL (0.91, 0.73, and 0.69, respectively; P < .001). The spleen volume ratio also showed significant increase from 3 mo in SVR (1.24, 1.34, and 1.42, respectively; P < .001) and 6 mo in SAL (1.31, 1.32, and 1.34, respectively; P < .001). SVR and SAL were significant risk factors for variceal formation at 12 mo (odds ratio, 21.0 and 20.3, respectively). Conclusion: In PD with PV resection, SAL delayed LSPH but could not prevent its occurrence. Abstract : The splenic vein division in pancreaticoduodenectomy with portal vein resection causes left‐sided portal hypertension (LSPH), which manifests as variceal formation and hemorrhage, thrombocytopenia and splenomegaly. Concomitant splenic artery ligation delayed but could not prevent development of LSPH; it did not cause variceal hemorrhage.