Abstract
Background
Five percent to 10% of chronic pancreatitis (CP) cases are complicated by portal venous
occlusion leading to extrahepatic generalized portal hypertension (GPH). Pancreatic
head resections (PHR) are regarded risky or contraindicated in patients with extrahepatic
GPH. The aim of our study was to analyze the outcome of patients with extrahepatic
GPH undergoing PHR for CP and to propose recommendations for surgical strategy.
Methods
Sixteen of 185 patients with PHR suffered from extrahepatic GPH . Perioperative and
follow-up data were documented prospectively and analyzed to assess the outcome.
Results
Preoperative interventional thrombolysis of the portal vein was successfully performed
in 5 patients and alleviated further PHR. Median operative time and blood transfusions
were higher in patients with extrahepatic GPH compared with patients without extrahepatic
GPH (P<.01). Overall complication rate was not statistically different (44% vs 34%). One
death occurred in each group. At the end of follow-up (median, 18 months) 13 of 15
patients with extrahepatic GPH were free of pain. No variceal bleeding or cholestasis
was documented. All patients judged their status as subjectively improved.
Conclusion
Although technically demanding in the presence of extrahepatic GPH, PHR can be performed
with an acceptable morbidity and mortality in an experienced center. Preoperative
interventional recanalization of portal vein thrombosis may render PHR possible by
restoring normal splanchnic blood flow in selected cases indicated for surgery.
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References
- Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients.Dig Dis Sci. 1992; 37: 340-346
- Vascular complications in chronic pancreatitis.Dig Surg. 1997; 14: 107-112
- Venous, biliary, and duodenal obstruction in chronic pancreatitis.Hepatogastroenterology. 1990; 37: 301-306
- Morphometrisch-statistische Analyse der Pankreasarterien bei Chronischer Pankreatitis.Virchows Arch A Pathol Anat. 1975; 365: 103-118
- Hypertension and segmental portal stasis in chronic pancreatitis. Apropos of 126 cases examined by splenoportography and splenomanometry.J Chir (Paris). 1968; 95: 599-608
- Splenoportographic changes in chronic pancreatitis.Surgery. 1968; 63: 571-575
- The significance of sinistral portal hypertension complicating chronic pancreatitis.Am J Surg. 2000; 179: 129-133
- Thrombosis of the portal and splenic vein.in: Beger H.G The Pancreas. 1st ed. Blackwell Science Ltd, Oxford2000: 854-862
- Splenic vein thrombosis and chronic pancreatitis: therapeutic approach.Schweiz Med Wochenschr. 1998; 128: 867-870
- Recognition and clinical implications of mesenteric and portal vein obstruction in chronic pancreatitis.Arch Surg. 1987; 122: 410-415
- A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis.Dig Surg. 2001; 18: 21-25
- Extrahepatic portal hypertension in chronic pancreatitis: an old problem revisited.Ann Surg. 2002; 236: 82-89
- Prospective randomized study of drainage and resection on non-occlusive segmental portal hypertension in chronic pancreatitis.Br J Surg. 1997; 84: 477-482
- Complications of chronic pancreatitis.Surg Clin North Am. 1989; 69: 481-497
- Segmental portal hypertension.Ann Surg. 1986; 204: 72-77
- Gastrointestinal hemorrhage from left-sided portal hypertension. An unappreciated complication of pancreatitis.Am J Surg. 1981; 141: 153-158
- Splenic complications in chronic pancreatitis: prevalence and risk factors in a medical-surgical series of 500 patients.Br J Surg. 1998; 85: 1645-1649
- Sinistral (left-sided) portal hypertension.Am Surg. 1990; 56: 758-763
- Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis.Surgery. 1985; 97: 467-473
- Description and rationale of a new operation for chronic pancreatitis.Pancreas. 1987; 2: 701-707
- Portal hypertension as a complication of chronic pancreatitis.Hepatogastroenterology. 1999; 46: 2582-2584
- Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy.Ann Surg. 1999; 230: 131-142
- Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators.J Gastrointest Surg. 2000; 4: 567-579
- Pancreatic fistula after pancreatic head resection.Br J Surg. 2000; 87: 883-889
- Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume.Ann Surg. 2000; 232: 786-795
Article info
Publication history
Accepted:
August 18,
2003
Freiburg and Rostock, GermanyFootnotes
☆Parts of this manuscript were presented as a poster at the meeting “Progress in Pancreatology—20 years in and outside Ulm,” held in Ulm, Germany, September, 6-8, 2001, and were published as an abstract in Langenbeck's Arch Surg 2001;386:392.
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
