Abstract
Background
The ligation of the splenic vein during pancreaticoduodenectomy with synchronous resection
of the spleno-mesenteric-portal venous confluence has been associated with the development
of left portal hypertension despite preservation of the natural confluence with the
inferior mesenteric vein. This study aimed to assess whether a left splenorenal venous
shunt might mitigate clinical signs of left portal hypertension associated with splenic
vein ligation.
Methods
We retrospectively evaluated the presence of left portal hypertension based on biologic
and radiologic parameters in patients undergoing pancreaticoduodenectomy with synchronous
resection of the spleno-mesentericoportal confluence between January 1, 2012, and
December 31, 2018. We compared several parameters between patients undergoing splenic
vein ligation with preservation of the inferior mesenteric vein confluence and a splenorenal
venous shunt: the early and late spleen volumes and spleen volume ratios, an early
and late platelet count, the presence of thrombocytopenia, the presence of varices,
and digestive bleeding in the long-term.
Results
There were 114 consecutive patients: 36 with splenic vein ligation and 78 with splenorenal
venous shunt. All had a pancreaticogastrostomy. Patients with splenic vein ligation
had a comparable baseline and early and late platelet counts. Although baseline splenic
volumes were comparable between the 2 groups (242 ± 115 mL vs 261 ± 138 mL; P = .51), patients with splenic vein ligation showed a statistically significant greater
splenic volume beyond the 6th postoperative months (334 ± 160 mL vs 241 ± 111 mL;
P = .004), higher early and late spleen volume ratios (1.42 ± 0.67 vs 1.10 ± 0.3; P = .001 and 1.38 ± 0.38 vs 0.97 ± 0.4; P = .0001) than patients with splenorenal venous shunt. Splenic vein ligation was also
associated with a higher rate of varices (81% vs 50%; P = .002) and more frequent varices with a caliber greater than 1 cm (57% vs 36%; P = .05) and more colonic varices (33% vs 12%; P = .01). Only 1 patient had long-term digestive bleeding (splenic vein ligation).
Conclusion
The left splenorenal shunt decreases clinical signs of left portal hypertension associated
with splenic vein ligation and inferior mesenteric vein confluence preservation.
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Article info
Publication history
Published online: June 11, 2020
Accepted:
April 16,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
