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Intraoperatively self-made bovine pericardial graft for portomesenteric reconstruction in pancreatic surgery

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Abstract

Purpose

Vascular encasement or infiltration of the portomesenteric veins can compromise resectability and local tumour control in pancreatic resections. So far, there is no consensus on how vascular reconstruction should be performed. Bovine pericardium has shown promising results, particularly in infected arterial vascular reconstructions. The aim of this study is to evaluate the feasibility and technical success of portomesenteric venous vascular reconstruction using bovine pericardium in pancreatic resections.

Methods

Retrospective analysis of portomesenteric reconstruction using bovine pericardium (patches, self-made tube grafts) in pancreatic resections between 2014 and 2019. The primary endpoint examined was the technical success rate and short-term patency of vascular reconstruction. In addition to clinical surveillance and laboratory routine testing, patency was tested with duplex scans (4 h postoperatively) and computed tomography imaging in case of an abnormal clinical course and as part of the oncological follow-up.

Results

In 15 surgical procedures (pancreaticoduodenectomy (12, 80%), pancreatic left resection (3, 20%)), vascular reconstruction was performed with superior mesenteric vein (6/15), portal vein (7/15) and the junction between superior mesenteric and splenic vein (2/15). Eighty percent of the reconstructions were tube grafts (12/15), and the remaining were patch plasties. In 13/15 (87%) of the cases, the vascular reconstruction was patent; in 2/15 (13%), there was one stenosis without reintervention need and one graft failure with complete thrombosis. Out of 15 patients, 4 major complications according to Clavien-Dindo classification (IIIa n = 2, 13%; IIIb n = 1, 7%; V n = 1, 7%) were documented. Latest re-imaging after surgery among the 10 patients with imaging follow-up more than 1 month postoperatively was after 6.5 months ((median, interquartile range 4–12 months), and clinical follow-up was at 6.7 months (median, 3.3–13 months)).

Conclusion

Due to its off-the-shelf availability, portomesenteric reconstruction using bovine pericardium seems to be a feasible and safe method in pancreatic resection with vascular encasement. Xenopericardial grafts can be crafted to any size and are applicable in potentially infected environment.

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Acknowledgements

We thank Mr. Vinci Naruka MA Hons. (Cantab.) MB BChir MRCS for cross-reading.

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Authors and Affiliations

  1. Department for Visceral, Thoracic and Vascular Surgery, Triemli Hospital Zurich, Zurich, Switzerland

    Laurin Burla, Igor Schwegler, Pascal Weibel, Markus Weber & Nicolas Attigah

  2. Department of Cardiothoracic Surgery, Harefield Hospital, Harefield, UK

    Alicja Zientara

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  1. Laurin Burla
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  2. Igor Schwegler
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  4. Markus Weber
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Contributions

Study conception and design: Laurin Burla, Igor Schwegler, Nicolas Attigah (supervision)

Acquisition of data: Laurin Burla, Pascal Weibel

Analysis and interpretation of data: Laurin Burla, Nicolas Attigah, Alicja Zientara

Drafting of manuscript: Laurin Burla

Critical revision of manuscript: Markus Weber, Alicja Zientara, Igor Schwegler, Nicolas Attigah

Corresponding author

Correspondence to Laurin Burla.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved prior to its initiation by the local ethics committee (Nr 2019-02323).

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Informed consent was obtained from all individual participants where appropriate included in the study.

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Burla, L., Schwegler, I., Weibel, P. et al. Intraoperatively self-made bovine pericardial graft for portomesenteric reconstruction in pancreatic surgery. Langenbecks Arch Surg 405, 705–712 (2020). https://doi.org/10.1007/s00423-020-01920-0

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