Utilizing Bifurcated Allogeneic Vein Grafts - A Novel Approach for Preventing Sinistral Portal Hypertension Following Pancreaticoduodenectomy

Q: What problem does the study address after pancreaticoduodenectomy?

Sinistral portal hypertension (SPH) can occur after pancreaticoduodenectomy, especially when S-M-P confluence resection is performed and splenic vein treatment is limited to ligation.

Q: How was the intervention compared in the retrospective part of the study?

The retrospective analysis compared bifurcated allogeneic vein reconstruction with simple splenic vein ligation, using clinicopathological data and statistical methods including log-rank tests and uni/multivariate analyses.

Q: What were the main outcomes related to SPH?

SPH-related indices (such as platelet counts, spleen volume, spleen volume ratio, and EGV grade) were better in the reconstruction group, and SPH incidence at 6 months was significantly higher in the ligation group.

Sep 24, 2026

Uploaded by Margaret

A before-and-after study evaluated whether bifurcated allogeneic vein replacement reduces sinistral portal hypertension (SPH) after pancreaticoduodenectomy in pancreatic carcinoma patients with spleno-mesenterico-portal (S-M-P) confluence resection. Retrospective data from 66 patients (2011–2021) compared bifurcated allogeneic vein reconstruction versus simple splenic vein ligation, and prospective data from 15 patients (2021–2023) assessed splenic vein reconstruction outcomes. SPH-related indices improved over time, and SPH incidence was lower with reconstruction.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Background

Materials and methods

Retrospective cohort

Prospective cohort

Results

Conclusions

Introduction

Rationale and prior surgical approaches

Definitions and clinical impact of SPH

’Before and After Study Utilizing bifurcated allogeneic vein grafts: a novel approach for preventing sinistral portal hypertension following pancreaticoduodenectomy. A 10-year before and after study Jing Wang, PhDa,b , Shao-cheng Lyu, PhDc , Song-ping Cui, PhDa , Jin-can Huang, MDc , Han-xuan Wang, MDc , Bin Hu, PhDa , Qiang He, PhDc,*, Ren Lang, PhDc,* Background: Sinistral portal hypertension (SPH) may occur in patients with pancreatic carcinoma after pancreaticoduodenectomy (PD) with spleno-mesenterico-portal (S-M-P) conﬂuence resection. This study aimed to evaluate outcomes with bifurcated allogeneic vein replacement in the prevention of SPH in pancreatic carcinoma patients. Materials and methods: A total of 81 patients were included. The authors retrospectively collected clinicopathological data from 66 patients underwent PD with S-M-P conﬂuence resection in our hospital from January 2011 to December 2021, compared the correlation between different venous reconstruction methods using log-rank tests and clinical outcomes through univariate and multivariate analyses. Secondly, the authors prospectively collected clinical data and outcomes of 15 patients who underwent splenic vein reconstruction from January 2021 to January 2023 . Results: In the retrospective study, 43 cases received reconstruction by bifurcated allogeneic vein (Reconstruction group) and 23 cases received simply SV ligation (Ligation group) . The preoperative platelet counts and spleen volume were similar between two groups (P> 0.05) . Nevertheless, at 1 month, 3 months and 6 months after operation, the related indexes of SPH such as platelet count, spleen volume, spleen volume ratio and esophagogastric varices (EGV) grade in Reconstruction group were better than those in Ligation group (P < 0.05) . 6 months after surgery, the incidence of SPH in Ligation group was signiﬁcantly higher than in Reconstruction group (36 .4% vs. 8. 1%, respectively) . In the prospective study, the incidence of SPH in patients undergoing SV reconstruction was 6 .7%(1/15) . Conclusions: Without compromising surgical outcomes, reconstruction of the S-M-P conﬂuence by bifurcated allogeneic vein is abetter method to avoid SPH in patients with advanced pancreatic carcinoma. Keywords: bifurcated allogeneic vein, pancreatic carcinoma, prognosis, sinistral portal hypertension, vascular reconstruction aDepartment of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China, bMass General Cancer Cennter, Mass General Brigham, Harvard Medical School and cDepartment of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China J.W., S.-C.L. and S.-P.C. contributed equally to this work Sponsorships or competing interests that maybe relevant to content are disclosed atthe end of this article. *Corresponding authors. Address: No. 8 Gongtinan Road, Chaoyang District, Beijing, PR China, 100020. Tel.: +86 010 85231504; fax: +86 010 85231503. [E-mail: heqiang349@sina.com](E-mail: heqiang349@sina.com) (Q. He); . Tel.: +86 010 85231504; fax: + [86 010 85231503. E-mail: dr_langren@126.com](86 010 85231503. E-mail: dr_langren@126.com) (R. Lang). Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. International Journal of Surgery (2025) 111:9–19 Received 5 April 2024; Accepted 30 June 2024 Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal's website, [www.lww.com/international-journal-of-surgery](www.lww.com/international-jour

FAQs

What problem does the study address after pancreaticoduodenectomy?

Sinistral portal hypertension (SPH) can occur after pancreaticoduodenectomy, especially when S-M-P confluence resection is performed and splenic vein treatment is limited to ligation.

How was the intervention compared in the retrospective part of the study?

The retrospective analysis compared bifurcated allogeneic vein reconstruction with simple splenic vein ligation, using clinicopathological data and statistical methods including log-rank tests and uni/multivariate analyses.

What were the main outcomes related to SPH?

SPH-related indices (such as platelet counts, spleen volume, spleen volume ratio, and EGV grade) were better in the reconstruction group, and SPH incidence at 6 months was significantly higher in the ligation group.

Sep 24, 2026

Uploaded by Margaret