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  • Title: Splenorenal shunt for reconstruction of the gastric and splenic venous drainage during pancreatoduodenectomy with resection of the portal venous confluence.
    Author: Al-Saeedi M, Frank-Moldzio L, Contin P, Mayer P, Loos M, Schmidt T, Schneider M, Müller-Stich BP, Berchtold C, Mehrabi A, Hackert T, Büchler MW, Strobel O.
    Journal: Langenbecks Arch Surg; 2021 Nov; 406(7):2535-2543. PubMed ID: 34618219.
    Abstract:
    BACKGROUND: Resection of the portal venous confluence is frequently necessary for radical resection during pancreatoduodenectomy for cancer. However, ligation of the splenic vein can cause serious postoperative complications such as gastric/splenic venous congestion and left-sided portal hypertension. A splenorenal shunt (SRS) can maintain gastric and splenic venous drainage and mitigate these complications. PURPOSE: This study describes the surgical technique, postoperative course, and surgical outcomes of SRS after pancreatoduodenectomy. METHODS: Ten patients who underwent pancreatoduodenectomy and SRS between September 2017 and April 2019 were evaluated. After resection an end-to-side anastomosis between the splenic vein and the left renal vein was performed. Postoperative shunt patency, splenic volume, and any SRS-related complications were recorded. RESULTS: The rates of short- and long-term shunt patency were 100% and 60%, respectively. No procedure-associated complications were observed. No signs of left-sided portal hypertension, such as gastrointestinal bleeding or splenomegaly, and no gastric/splenic ischemia were observed in patients after SRS. CONCLUSION: SRS is a safe and effective measure to mitigate gastric congestion and left-sided portal hypertension after pancreatoduodenectomy with compromised gastric venous drainage after resection of the portal venous confluence.
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