Skip to main content
SpringerLink
Log in

the role of splenomesenteric vein anastomosis after division of the splenic vein in pancreatoduodenectomy

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Division of the splenic vein was performed in 29 patients who underwent pancreatoduodenectomy to achieve lymph node dissection and neural resection around the superior mesenteric artery. The basic protocol for the splenic vein reconstruction to reduce congestion of the spleen and stomach is as follows. When the inferior mesenteric vein (IMV) drained into the splenic vein, the confluence was preserved without reconstruction of the splenic vein. When the IMV drained into the superior mesenteric vein (SMV) or the splenomesenteric angle, the division of the IMV and spleno-IMV anastomosis were performed. In postoperative venography, nine patients showed downward flow (from the splenic vein to the IMV) and three patients showed upward flow (from the IMV to the splenic vein). Postoperative computed tomography scans showed venous dilatation and splenomegaly in the upward flow group; there were no patients in the downward flow group. In selected patients, splenic vein reconstruction is necessary to reduce congestion of the spleen and stomach. When the flow is downward, spleno-IMV flow should be preserved. When the flow is upward, spleno-SMV anastomosis is necessary instead of spleno-IMV anastomosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fu F, Ming Sheen S, Sen Y, Chan M, Long C. Postoperative morbidity and mortality of pancreaticoduodenectomy for periampullary cancer. Eur J Surg 1996;162:477–481.

    Google Scholar 

  2. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s. Ann Surg 1997; 226:248–260.

    Article  PubMed  CAS  Google Scholar 

  3. Bottger TC, Junginger T. Factors influencing morbidity and mortality after pancreaticoduodenectomy: Critical analysis of 221 resections. World J Surg 1999;23:164–172.

    Article  PubMed  CAS  Google Scholar 

  4. Henne-Bruns D, Vogel I, Luttges J, Kloppel G, Kremer B. Surgery for ductal adenocarcinoma of the pancreatic head: Staging, complications, and survival after regional versus extended lymphadenectomy. World J Surg 2000;24:595–602.

    Article  PubMed  CAS  Google Scholar 

  5. Gazzaniga GM, Cappato S, Papadia F, Mori L, Filauro M. D1 versus D2 pancreatoduodenectomy in surgical therapy of pancreatic head cancer. Hepatogastroenterology 2001;48:1471–1478.

    PubMed  CAS  Google Scholar 

  6. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2. Ann Surg 2002;236:355–368.

    Article  PubMed  Google Scholar 

  7. Ishikawa O, Ohhigashi H, Sasaki Y. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg 1988;208:216–220.

    Article  Google Scholar 

  8. Manabe T, Ohshio G, Baba N. Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer 1989;64:1132–1137.

    Article  PubMed  CAS  Google Scholar 

  9. Pedrazzoli S, DiCarlo V, Dionigi R, et al. Lymphadenectomy Study Group. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas. Ann Surg 1998;228:508–517.

    Article  PubMed  CAS  Google Scholar 

  10. Benassai G, Mastrorilli M, Mosella F, Mosella G. Significance of lymph node metastases in the surgical management of pancreatic head carcinoma. J Exp Clin Cancer Res 1999;18:23–28.

    PubMed  CAS  Google Scholar 

  11. Nagakawa T, Kobayashi H, Ueno K, Ohta T, Kayahara M, Miyazaki I. Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas. Cancer 1994;73:1155–1162.

    Article  PubMed  CAS  Google Scholar 

  12. Takahashi S, Ogata Y, Aiura K, Kitajima M, Hiramatsu K. Combined resection of the portal vein for pancreatic cancer: Preoperative diagnosis of invasion by portography and prognosis. Hepatogastroenterology 2000;47:545–549.

    PubMed  CAS  Google Scholar 

  13. Traverso LW, Longmire WP. Preservation of the pylorus in pancreatoduodenectomy. Surg Gynecol Obstet 1978;146:956–962.

    Google Scholar 

  14. Takada T. Pylorus-preserving pancreatoduodenectomy: Technique and indications. Hepatogastroenterology 1993;40:422–425.

    PubMed  CAS  Google Scholar 

  15. Hagihara K. Experimental and clinicopathological studies on lymphatic flow of the pancreas. Igaku Kenkyu 1982;52:61–85.

    PubMed  CAS  Google Scholar 

  16. Fortner JG. Technique of regional subtotal and total pancreatectomy. Am J Surg 1985;150:593–600.

    Article  PubMed  CAS  Google Scholar 

  17. Suhocki PV, Berend KR, Trotter JF. Idiopathic splenic vein stenosis: A cause of gastric variceal hemorrhage. South Med J 2000;93:812–814.

    PubMed  CAS  Google Scholar 

  18. McDermott V, England R, NewmanG. Case report: Bleeding gastric varices secondary to splenic vein thrombosis successfully treated by splenic artery embolization. Br J Radiol 1995; 68:928–930.

    Article  PubMed  CAS  Google Scholar 

  19. Sato T, Yamazaki K, Toyota J, Karino Y, Ohmura T, Suga T. Gastric varices with splenic vein occlusion treated by splenic arterial embolization. J Gastroenterol 2000;35:290–295.

    Article  PubMed  CAS  Google Scholar 

  20. Cusack JC, Fuhrman GM, Lee JE, Evans DB. Managing unsuspected tumor invasion of the superior mesenteric-portal venous confluence during pancreaticoduodenectomy. Am J Surg 1994;168:352–354.

    Article  PubMed  Google Scholar 

  21. Graf O, Boland GW, Kaufman JA, Warshaw AL, Castillo CF, Mueller PR. Anatomic variants of mesenteric veins: Depiction with helical CT venography. Am J Roentgenol 1997;168:1209–1213.

    CAS  Google Scholar 

  22. Tamura K, Sumi S, Koike M, Yano S, Nagami H, Nio Y. A splenic-inferior mesenteric venous anastomosis prevents gastric congestion following pylorus preserving pancreatoduodenectomy with extensive portal vein resection for cancer of the head of the pancreas. Int Surg 1997;82:155–159.

    PubMed  CAS  Google Scholar 

  23. Nussbaum MS, Li S, Bower RH, McFadden DW, Dayal R, Fischer JE. Addition of lipid to total parenteral nutrition prevents hepatic steatosis in rats by lowering the portal venous insulin/glucagon ratio. J Parental Enterol Nutr 1992;16:106–109.

    Article  CAS  Google Scholar 

  24. Li S, Nussbaum MS, McFadden DW, et al. Addition of Lglutamine to total parenteral nutrition and its effects on portal insulin and glucagon and the development of hepatic steatosis in rats. J Surg Res 1990;48:421–426.

    Article  PubMed  CAS  Google Scholar 

  25. Bremmer DR, Trower SL, Bertics SJ, Besong SA, Bernabucci U, Grummer RR. Etiology of fatty liver in dairy cattle: Effects of nutritional and hormonal status on hepatic microsomal triglyceride transfer protein. J Dairy Sci 2000;83:2239–2251.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Surgery, Yokohama City University, School of Medicine, Kanazawa-ku, Yokohama, Japan

    Koichiro Misuta M.D., Hiroshi Shimada M.D., Ph.D., Yasuhiko Miura M.D., Ph.D., Osamu Kunihiro M.D., Toru Kubota M.D., Ph.D., Itaru Endo M.D., Ph.D., Hitoshi Sekido M.D., Ph.D. & Shinji Togo M.D., Ph.D.

Authors
  1. Koichiro Misuta M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroshi Shimada M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasuhiko Miura M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Osamu Kunihiro M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toru Kubota M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Itaru Endo M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hitoshi Sekido M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shinji Togo M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Koichiro Misuta M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Misuta, K., Shimada, H., Miura, Y. et al. the role of splenomesenteric vein anastomosis after division of the splenic vein in pancreatoduodenectomy. J Gastrointest Surg 9, 245–253 (2005). https://doi.org/10.1016/j.gassur.2004.06.003

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.gassur.2004.06.003

Key Words

Search

Navigation