Pancreaticoduodenectomy with Reconstruction of the Mesentericoportal Vein by the Parietal Peritoneum: 'Safi Dokmak Vascular Graft'.

BACKGROUND

Venous resections are frequent during hepatopancreatobiliary (HPB) surgery and a rapidly available graft may be needed, especially if it had not been planned preoperatively.1 (-) 3 Our group recently reported results on the use of the parietal peritoneum (PP) as an autologous substitute graft (ASG) for reconstruction of the mesentericoportal vein (MPV) in 30 patients for the first time.4

METHODS

Between December 2010 and January 2015, a total of 52 patients underwent HPB surgery with venous resection/reconstruction with the PP. The PP was harvested rapidly through the same surgical incision in the same surgical field, and reconstruction was generally performed after the specimen was removed. The ASG was harvested from the PP of the diaphragm (n = 22), the hypochondrium (n = 19), the falciform ligament (n = 6) and the prerenal area (n = 5), and used as a lateral (n = 49) or tubular (n = 3) graft. The presence of peritoneal carcinomatosis was a contraindication. Postoperative anticoagulation was standard and venous patency was assessed by routine computed tomography (CT) scan in all patients. All data were collected prospectively and complications were recorded according to the Clavien-Dindo classification.5 Our experience is illustrated in a patient who underwent pancreaticoduodenectomy with reconstruction of the MPV, using the PP, for recurrent pancreatic adenocarcinoma on an intraductal papillary mucinous neoplasia, and who was treated 5 years ago by distal pancreatectomy.

RESULTS

Overall, 32 men and 20 women, mean age 60 years (range 31-83), underwent resection of the pancreas (n = 29), the liver (n = 22), or both (n = 1). Mean size of the ASG was 23 mm (range 10-80), and it was used for reconstruction of the MPV (n = 42), the hepatic veins (n = 5), or the vena cava (n = 5) for malignant disease (98 %). Emergency reconstruction was necessary in six patients due to prolonged vascular occlusion. One non-related mortality was observed (2 %) as a result of septic complications after right hepatectomy. Eight (15 %) complications were greater than grade III of the Clavien-Dindo classification, but there were no PP-related or hemorrhagic complications. Mean hospital stay was 16 days (range 6-48). After a mean follow-up of 11 months (range 1-46), the overall patency rate was 96, 100 % for the lateral graft, and 33 % for the tubular graft.

CONCLUSIONS

The Safi Dokmak vascular graft using the PP for lateral reconstruction of the MPV may be harvested rapidly with no limitation in size, can be temporarily used, and is inexpensive and safe. Finally, therapeutic anticoagulation is not needed and the theoretical risk of infection is very low.