|
|
|
| Sinistral portal hypertension and distal splenorenal shunt during pancreatic surgery |
| Tomohide Hori ∗, Ryuhei Aoyama, Hidekazu Yamamoto, Hideki Harada, Michihiro Yamamoto, Masahiro Yamada, Takefumi Yazawa, Masazumi Zaima |
Department of Surgery, Shiga General Hospital, 5-4-30 Moriyama, Moriyama City, Shiga Prefecture, 524-8524, Japan
∗ Corresponding author.
E-mail address: horitomo55office@yahoo.co.jp (T. Hori). |
|
|
|
|
Abstract Locally advanced pancreatic cancer located in the head or uncinate process ( i.e. , uncus) often invades the confluence of the superior mesenteric vein (SMV), portal vein (PV), and splenic vein (SV) [1,2]. Additionally, chronic pancreatitis easily occludes drainage flow via the SV [3]. These pancreatic diseases force surgeons to perform en bloc resection of the SV. Simple ligation of the remnant SV without venous resection results in sinistral portal hypertension (PH) ( i.e. , left-sided PH), gastrointestinal bleeding, splenic congestion, and hypersplenism over the long term [1,2 ]. Postoperative sinistral PH is considered an intractable complication accompanied by refractory symptoms similar to those of PH due to liver cirrhosis [1,2]. Optimal management of the remnant SV is required during surgery [1,2]; however, intentional venous reconstruction for drainage flow of the SV is still controversial [1,2,4-8 ]. We herein focus on sinistral PH due to occlusion of drainage flow via the SV, present actual characteristics in typical cases of pancreatic cancer and chronic pancreatitis, and discuss a strategic adaptation of the distal splenorenal shunt (DSRS) procedure.
|
|
|
|
|
|
|
|
|
2022, Vol. 21 
