Advertisement

Annals of Surgical Oncology

, Volume 23, Issue 8, pp 2664–2664 | Cite as

Laparoscopic Pancreaticoduodenectomy with Reconstruction of the Portal Vein with the Parietal Peritoneum

  • Safi DokmakEmail author
  • Rim Chérif
  • Igor Duquesne
  • Raphaêlle Delattre
  • Béatrice Aussilhou
  • Olivier Soubrane
  • Alain Sauvanet
Pancreatic Tumors

Abstract

Introduction

Laparoscopic pancreaticoduodenectomy (LPD) is increasingly used for resections of periampullary tumors, including pancreatic adenocarcinoma.1 LPD with venous resection–reconstruction (VRR) has already been performed with or without vascular graft.2 , 3 The parietal peritoneum (PP) was recently described for reconstruction of the mesenterico-portal vein, with excellent results.4

Patients and Methods

Between April 2011 and May 2015, a total of 64 LPDs were performed in our department; however, only one patient underwent VRR. Compared with the open approach, full mobilization of the mesentery and right liver is not systematically carried out and, theoretically, vascular grafts may be more frequently needed with LPD. In this video, LPD for pancreatic adenocarcinoma with resection of the lateral right side of the portal vein (>25 mm) was performed. Reconstruction was achieved rapidly, as a lateral patch, with the falciform ligament.

Results

Surgery lasted 360 min, 60 min of portal vein occlusion, 200 ml of blood loss, and uneventful stay. Since 2010, the PP has been used as a lateral patch in 69 patients operated by open (n = 68) or laparoscopic approach (n = 1). Although handling and suturing can be difficult, no bleeding complications related to the PP were observed and the permeability rate was >95 %.

Conclusion

LPD is still restricted to selected centers, with conflicting results regarding safety; however, venous resection may be required. We feel that with the laparoscopic approach, vascular grafts are more frequently needed and the PP has many advantages compared with an open approach, including easy access, unlimited size, and rapid harvesting.

Keywords

Portal Vein Pancreatic Adenocarcinoma Pancreatic Ductal Adenocarcinoma Vascular Graft Parietal Peritoneum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

Safi Dokmak, Rim Chérif, Igor Duquesne, Raphaêlle Delattre, Béatrice Aussilhou, Olivier Soubrane, and Alain Sauvanet declare no conflicts of interest.

Supplementary material

Supplementary material 1 (MP4 90916 kb)

References

  1. 1.
    Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg. 2014;260(4):633–40.CrossRefPubMedGoogle Scholar
  2. 2.
    Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford). 2011;13(7):454–8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Awad ZT. Totally laparoscopic pancreaticoduodenectomy for pancreatic head cancer with involvement of the superior mesenteric vein-portal vein confluence. Ann Surg Oncol. 2014;21(11):34–9.CrossRefGoogle Scholar
  4. 4.
    Dokmak S. Pancreaticoduodenectomy with reconstruction of the mesentericoportal vein by the parietal peritoneum: ‘Safi Dokmak vascular graft’. Ann Surg Oncol. 2015;22 Suppl 3:343–4.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Safi Dokmak
    • 1
    Email author
  • Rim Chérif
    • 1
  • Igor Duquesne
    • 1
  • Raphaêlle Delattre
    • 2
  • Béatrice Aussilhou
    • 1
  • Olivier Soubrane
    • 1
  • Alain Sauvanet
    • 1
  1. 1.Department of HPB Surgery and Liver TransplantationBeaujon HopsitalClichyFrance
  2. 2.Department of Anesthesia-ReanimationBeaujon HopsitalClichyFrance

Personalised recommendations