Ann Hepatobiliary Pancreat Surg.  2024 Feb;28(1):99-103. 10.14701/ahbps.23-089.

Gastric salvage after venous congestion during major pancreatic resections: A series of three cases

• Reddy RC
• Chaudhari V
• Chopde A
• Mitra A
• Jaiswal D
• Shrikhande SV
• Bhandare MS

• KMID: 2553371
• DOI: http://doi.org/10.14701/ahbps.23-089

Abstract

Pancreatic resections, depending on the location of the tumor, usually require division of the vasculature of either the distal or proximal part of the stomach. In certain situations, such as total pancreatectomy and/or with splenic vein occlusion, viability of the stomach may be threatened due to inadequate venous drainage. We discuss three cases of complex pancreatic surgeries performed for carcinoma of the pancreas at a tertiary care center in India, wherein the stomach was salvaged by reimplanting the veins in two patients and preserving the only draining collateral in one case after the gastric venous drainage was compromised. The perioperative and postoperative course in these patients and the complications were analyzed. None of these 3 patients developed any complication related to gastric venous congestion, and additional gastrectomy was avoided in all these patients. Re-establishment of the Gastric venous outflow after extensive pancreatic resections helps to avoid additional gastric resection secondary to venous congestive changes.

Keyword

Pancreatic cancer; Pancreatic surgery; Extended pancreatic resections; Gastric venous drainage; Gastric congestion

Figure

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  Fig. 1 (A) End-to-side microvascular anastomosis between the CV (white arrow) and IMV (blue arrow). (B) End-to-end microvascular anastomosis between the RGEV (white arrow) and colic vein (blue arrow). CV, coronary vein; IMV, inferior mesenteric vein; RGEV, right gastroepiploic vein.

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  Fig. 2 (A) CT showing a borderline resectable tumour with spleno-portal confluence involvement: a red dotted circle showing the area of involvement. (B) A pancreatic mass (yellow arrow) invading the portal vein and SMV confluence. The preserved RGEV (white arrow) is seen draining into the SMV (Looped by a blue vessel tape and marked by a black arrowhead). SA, splenic artery; CHA, common hepatic artery; RGEV, right gastroepiploic vein; SMV, superior mesenteric vein.

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  Fig. 3 Post-resection photograph showing a dilated RGEV (white arrow) draining into the SMV. The CHA (yellow arrow) and SA (red arrow), and end-to-end venous anastomosis (black arrow) are seen. RGEV, right gastroepiploic vein; MPV, main portal vein; CHA, common hepatic artery; SA, splenic artery; SMV, superior mesenteric vein.

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  Fig. 4 (A) The LGV (blue arrow)-RGEV (black arrow) common venous conduit. (B) Anastomosis of the common venous conduit (highlighted in black dotted lines) to the MPV (black arrow). LGV, left gastric vein; RGEV, right gastroepiploic vein; MPV, main portal vein.

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  Fig. 5 Gastric venous congestion before (left) and after (right) venous reconstruction. Decongested omental veins can be noted in the right-sided picture.

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