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American Journal of Surgery Dec 2018No standard classification exists for post-splenectomy thrombosis of splenic, mesenteric, and portal vein (PST-SMPv). The goal of this study was to review our...
Postsplenectomy thrombosis of splenic, mesenteric, and portal vein (PST-SMPv): A single institutional series, comprehensive systematic review of a literature and suggested classification.
OBJECTIVES
No standard classification exists for post-splenectomy thrombosis of splenic, mesenteric, and portal vein (PST-SMPv). The goal of this study was to review our institution's experience with PST-SMPv and to perform a systematic literature review.
METHODS
A retrospective review of all patients undergoing splenectomy from 1995-2016 at our institution was performed. Additionally, six databases and four grey literature websites were systematically searched. Splenectomy for pediatric patients or for trauma or portal hypertension related reasons were excluded.
RESULTS
Between 1995 and 2016, 229 patients (113; 49.3% males) underwent splenectomy for spleen related diseases at our institution. From 1895 to 2016, 1645 unique literature citations were identified. Twenty citations met our inclusion criteria. Data on 1745 splenectomized patients was compiled; PST-SMPv occurred in 141 (8.1%).
CONCLUSIONS
In our series, PST-SMPv developed in 6.6% of patients and the incidence of PST-SMPv after splenectomy in the literature ranges from 0.8 - 53.0%. A call for standardized reporting through a proposed classification is made.
Topics: Humans; Incidence; Mesenteric Veins; Portal Vein; Postoperative Complications; Splenectomy; Splenic Vein; Venous Thrombosis
PubMed: 30390936
DOI: 10.1016/j.amjsurg.2018.01.073 -
Clinical Anatomy (New York, N.Y.) Sep 2018There have been many reports of altered pancreas size in diseases of the endocrine and exocrine pancreas, but few attempts to quantify such changes. The aim of this...
There have been many reports of altered pancreas size in diseases of the endocrine and exocrine pancreas, but few attempts to quantify such changes. The aim of this study was to conduct a systematic literature review, documenting the methodology, and quantitative data in studies reporting on pancreas size. Three electronic databases (Embase, Scopus, and MEDLINE) were searched by two reviewers independently. Studies of humans were included if they compared pancreas size (reported as pancreas diameters, areas, and/or lengths) between diseased populations and controls. A total of 28 studies with 3,810 individuals were included. Among these, 22 measured pancreas diameters, seven measured pancreas areas, and one measured pancreas lengths. The most common landmark for the head of the pancreas was the confluence of the superior mesenteric and splenic veins (three out of nine studies, 33.3%); for the body it was the superior mesenteric artery (seven out of nine, 77.8%); for the tail it was the internal border of the left kidney (two out of six, 33.3%). Pancreas diameters and areas tended to be smaller in diabetes mellitus, the extent of reduction being greater in individuals with type 1 than type 2 diabetes. Pancreas diameters tended to be greater in acute pancreatitis and pancreatic cancer but not in chronic pancreatitis. Pancreas diameters are a clinically relevant measure for diseases of the endocrine and exocrine pancreas. Consensus guidelines need to be developed to standardize their measurements. Clin. Anat. 31:913-926, 2018. © 2018 Wiley Periodicals, Inc.
Topics: Case-Control Studies; Diabetes Mellitus; Humans; Organ Size; Pancreas; Pancreatic Neoplasms; Pancreatitis; Reference Values
PubMed: 29873108
DOI: 10.1002/ca.23217 -
Pancreas Sep 2021The portal vein (PV)-superior mesenteric vein (SMV) margin is the most affected margin in pancreatic cancer. This study investigates the association between venous...
OBJECTIVES
The portal vein (PV)-superior mesenteric vein (SMV) margin is the most affected margin in pancreatic cancer. This study investigates the association between venous resection, tumor invasion in the resected PV-SMV, recurrence patterns, and overall survival (OS).
METHODS
This multicenter cohort study included patients who underwent pancreatoduodenectomy for pancreatic cancer (2010-2017). In addition, a systematic literature search was performed.
RESULTS
In total, 531 patients were included, of which 149 (28%) underwent venous resection of whom 53% had tumor invasion in the resected PV-SMV. Patients with venous resection had a significant higher rate of R1 margins (69% vs 37%) and had more often multiple R1 margins (43% vs 16%). Patient with venous resection had a significant shorter time to locoregional recurrence and a shorter OS (15 vs 19 months). At multivariable analyses, venous resection and tumor invasion in the resected PV-SMV were not predictive for time to recurrence and OS. The literature overview showed that pathological assessment of the resected PV-SMV is not adequately standardized.
CONCLUSIONS
Only half of patients with venous resection had pathology confirmed tumor invasion in the resected PV-SMV, and both are not independently associated with time to recurrence and OS. The pathological assessment of the resected PV-SMV needs to be standardized.
Topics: Aged; Female; Humans; Male; Mesenteric Veins; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein; Retrospective Studies; Survival Rate
PubMed: 34714287
DOI: 10.1097/MPA.0000000000001897 -
Surgery Sep 2020Pancreatoduodenectomy with synchronous resection of the portal vein/superior mesenteric vein confluence may result in the development of left-sided portal hypertension....
BACKGROUND
Pancreatoduodenectomy with synchronous resection of the portal vein/superior mesenteric vein confluence may result in the development of left-sided portal hypertension. Left-sided portal hypertension presents with splenomegaly and varices and may cause severe gastrointestinal bleeding. The aim of the study is to review the incidence, treatment, and preventive strategies of left-sided portal hypertension.
METHODS
A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to identify all studies published up to September 30, 2019 reporting data on patients with left-sided portal hypertension after pancreatoduodenectomy with venous resection.
RESULTS
Eight articles including 829 patients were retrieved. Left-sided portal hypertension occurred in 7.7% of patients who had splenic vein preservation and 29.4% of those having splenic vein ligation. Fourteen cases of gastrointestinal bleeding owing to left-sided portal hypertension were reported at a mean interval of 28 months from pancreatoduodenectomy. Related mortality at 1 month was 7.1%. Treatment of left-sided portal hypertension consisted of splenectomy in 3 cases (21%) and colectomy in 1 (7%) case, whereas radiologic, endoscopic procedures or conservative treatments were effective in the other cases (71%).
CONCLUSION
Left-sided portal hypertension represents a potentially severe complication of pancreatoduodenectomy with venous resection occurring at greater incidence when the splenic vein is ligated and not reimplanted. Left-sided portal hypertension-related gastrointestinal bleeding although rare can be managed depending on the situation by endoscopic, radiologic procedures or operative intervention with low related mortality.
Topics: Carcinoma, Pancreatic Ductal; Colectomy; Conservative Treatment; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Incidence; Ligation; Mesenteric Veins; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein; Postoperative Complications; Splenectomy; Splenomegaly; Treatment Outcome
PubMed: 32600882
DOI: 10.1016/j.surg.2020.04.030 -
Clinical Anatomy (New York, N.Y.) Nov 2018Surgeons have recognized the clinical significance of the venous trunk of Henle during multiple pancreatic, colorectal, and hepatobiliary procedures. To date, no study... (Meta-Analysis)
Meta-Analysis
Surgeons have recognized the clinical significance of the venous trunk of Henle during multiple pancreatic, colorectal, and hepatobiliary procedures. To date, no study has followed the principles of evidence-based anatomy to characterize it. Our aim was to find, gather, and systematize available anatomical data concerning this structure. The MEDLINE/PubMed, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science databases were searched. The following data were extracted: prevalence of the trunk of Henle, its mean diameter and length, the organization of its tributaries, method of anatomical assessment (cadaveric, radiological, or intraoperative), geographical origin, study sample, and known health status. Our search identified 38 records that included data from 2,686 subjects. Overall, the prevalence of the trunk of Henle was 86.9% (95% CI, 0.81-0.92) and the mean diameter was 4.2 mm. Only one study reported the length of the trunk (10.7 mm). The most common type of venous trunk (56.1%) was a vessel comprising three tributaries: gastric (right gastro-epiploic vein), pancreatic (most commonly the anterior superior pancreaticoduodenal vein), and colic (most commonly the superior right colic vein). The trunk of Henle is a common variant in the anatomy of the portal circulation. It is a highly variable vessel, but the most common type is a gastro-pancreato-colic trunk. In surgical practice, the presence of this venous trunk poses a high risk for bleeding, but it can also be a useful landmark during various abdominal procedures. Clin. Anat. 31:1109-1121, 2018. © 2018 Wiley Periodicals, Inc.
Topics: Abdomen; Colon; Humans; Mesenteric Veins; Pancreas
PubMed: 30133829
DOI: 10.1002/ca.23228 -
Journal of Vascular Surgery. Venous and... Mar 2024Thrombi in the axial calf veins have quite different anatomical and physiological characteristics from that in the muscular calf veins, but their treatment was usually... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Thrombi in the axial calf veins have quite different anatomical and physiological characteristics from that in the muscular calf veins, but their treatment was usually addressed in the same manner. We performed a meta-analysis of randomized and cohort studies to compare clinical outcomes among patients with isolated axial vs muscular calf deep vein thrombosis (DVT).
METHODS
Recurrent venous thromboembolism (VTE) was selected as the primary outcome. Resolution, proximal propagation of calf DVT, pulmonary embolism (PE), major bleeds, and clinically relevant non-major bleeds were separately analyzed as secondary outcomes. Data were pooled and compared with risk ratio (RR) and 95% confidence interval (CI).
RESULTS
Thirteen studies, consisting of 4889 patients, met the inclusion criteria and were included for analysis. A greater rate of recurrent VTE (FE model: RR, 1.23; 95% CI, 1.00-1.53; I = 29%), resolution (FE model: RR, 1.32; 95% CI, 1.01-1.72; I = 31%), proximal propagation (FE model: RR, 1.63; 95% CI, 1.10-2.41; I = 40%), and PE (FE model: RR, 2.79; 95% CI, 1.31-5.95; I = 0%) in the axial group compared with the muscular group. There was no difference in the pooled estimates for major bleeds (FE model: RR, 1.09; 95% CI, 0.61-1.95; I = 0%), and clinically relevant non-major bleeds (FE model: RR, 1.80; 95% CI, 0.93-3.48) in the axial and muscular arms.
CONCLUSIONS
Patients with calf DVT limited to muscular veins might have a lower rate of recurrent VTE, resolution, proximal propagation, and PE vs those with axial calf vein involvement and exhibited similar safety outcomes.
Topics: Humans; Anticoagulants; Venous Thromboembolism; Mesenteric Ischemia; Venous Thrombosis; Pulmonary Embolism; Hemorrhage
PubMed: 38043681
DOI: 10.1016/j.jvsv.2023.101727 -
Obesity Research & Clinical Practice 2018Porto-mesenteric venous thrombosis (PMVT) is a rare but fatal complication after bariatric surgery. However, an increasing number of PMVT complications have been...
INTRODUCTION
Porto-mesenteric venous thrombosis (PMVT) is a rare but fatal complication after bariatric surgery. However, an increasing number of PMVT complications have been observed in the last years after laparoscopic sleeve gastrectomy (LSG) operations.
CASE REPORT
A 35-year-old male was admitted to the emergency clinic in a septic status with a sudden once of abdominal pain and vomiting. The patient underwent laparoscopic sleeve gastrectomy (LSG) 15 days ago. His physical examination revealed diffuse abdominal tenderness. Abdominal computerised tomography showed a thrombus which was elongated from vena mesenterica superior to vena porta. An emergent laparotomy was performed. A 40 cm of ischemic small bowel segment which began at the 60th cm of Treitz ligament was resected. The gastrointestinal continuity was provided by an end-to-end anastomosis. Patient's postoperative course was uneventful. He was discharged on the 7th postoperative day and was medicated on oral anticoagulation (Warfarin 5 mg/day) for six months.
RESULTS
A total of 104 morbidly obese patients who developed PMVT after bariatric surgery are reported in the English literature between 2004 and April 2017. Most of the patients were female (63 cases, 60.5%). The median age was 42.5 years (14-68) and the median body mass index (BMI) was 44 kg/m (31.8-74.6). The most common cause of coagulopathy disorders was protein C and/or S deficiency (9.6%) followed by prothrombin gene mutation (6.7%). LSG was performed in 83 patients (78.8%) and the median intraoperative pressure was 15 mmHg (14-20). The median operation time was 70 min (min-max: 37-192). Fifty-five patients (52.8%) underwent preoperative oral anticoagulant prophylaxis. The median time for PMVT development was 14 days (min-max: 1-453). Of the 104 patients with PMVT, 75 cases (72.1%) underwent postoperative anticoagulant agents such as low-molecular weight heparin (LMWH), heparin drip or infusion, streptokinase or warfarin, whereas the remaining did not receive prophylactic medication.
CONCLUSION
PMVT after sleeve gastrectomy is a rare but fatal complication. Therefore, anti-coagulation prophylaxis with LMWH should be considered at least one month postoperatively.
Topics: Abdominal Pain; Adult; Anastomosis, Surgical; Anticoagulants; Bariatric Surgery; Humans; Laparotomy; Male; Mesenteric Ischemia; Mesenteric Veins; Obesity, Morbid; Portal Vein; Postoperative Complications; Treatment Outcome; Venous Thrombosis; Vomiting
PubMed: 29310972
DOI: 10.1016/j.orcp.2017.12.002 -
BMC Surgery Jul 2019Although pancreaticoduodenectomy with vein resection (PDVR) is widely performed in selected patients with indications, its benefits remain controversial. In this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although pancreaticoduodenectomy with vein resection (PDVR) is widely performed in selected patients with indications, its benefits remain controversial. In this meta-analysis, we evaluate the safety and efficacy of PDVR in comparison to standard pancreaticoduodenectomy (PD).
METHODS
We searched PubMed, Embase, and Cochrane as well as the Chinese National Knowledge Infrastructure, Weipu, and Wanfang databases for studies that evaluate the value of PVDR. The data of the patients who underwent PD or PDVR were analyzed using Review Manager and STATA software.
RESULTS
In comparison with the PD group, the PDVR group had a lower R0 resection rate and higher rates of complications such as biliary fistula, reoperation rate, delayed gastric emptying, cardiopulmonary abnormalities, hemorrhage, in-hospital mortality, 30-day mortality. The blood loss, duration of operation, total hospital stay is higher in PDVR group.
CONCLUSIONS
Compared to standard PD, PDVR was associated with a greater risk of some specific complications and increase the mortality rate, total hospital stay time, combine with vein resection have a lower R0 resection rate. Therefore, combine with vascular resection for pancreatic cancer needs to be carefully selected by the surgeon.
Topics: Carcinoma, Pancreatic Ductal; Humans; Mesenteric Veins; Neoplasm Invasiveness; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein; Treatment Outcome; Vascular Neoplasms; Vascular Surgical Procedures
PubMed: 31286916
DOI: 10.1186/s12893-019-0540-6 -
The American Journal of Emergency... Jul 2021Hepatic portal pneumatosis has a high mortality rate, and whether surgical intervention is necessary remains controversial. This experiment retrospectively analyzed the...
OBJECTIVE
Hepatic portal pneumatosis has a high mortality rate, and whether surgical intervention is necessary remains controversial. This experiment retrospectively analyzed the etiology, treatment methods and prognosis of adult patients with hepatoportal pneumocele to provide a theoretical basis for the treatment of this disease.
METHODS
We analyzed the clinical symptoms and post-treatment of a 43-year-old male patient with HPVG admitted to hospital. We retrieved adult non-iatrogenic HPVG cases with complete clinical data in PUBMED, and MEDLINE and other databases were retrieved for analysis, and summarized the pathogenesis, clinical symptoms, pathogenesis, pathogenesis and prognosis of different treatment schemes were summarized.
RESULTS
The main etiology of HPVG are intestinal ischemia (27%), severe enteritis/intestinal perforation/intestinal fistula (16%), intestinal obstruction (7%), abdominal infection (7%), gastric diseases (11%), appendicitis and its complications (5%), acute hemorrhage or necrotizing pancreatitis (5%), Crohn's disease and its complications (4%), trauma (traffic accidents, falls) (2%), diverticulitis and perforation (6%), nephrogenic diseases (4%), spontaneous pneumohepatic portal vein (2%), other reasons (4%). And after analysis, we found that the survival rate of patients treated by surgery was 40.5% and the mortality rate was 19.1%, the difference between the two was significant.
CONCLUSIONS
Etiology should be actively explored and surgical treatment is necessary.
Topics: Adult; Embolism, Air; Fatal Outcome; Hepatic Veins; Humans; Male; Mesenteric Veins; Portal Vein; Shock, Septic; Tomography, X-Ray Computed
PubMed: 32739095
DOI: 10.1016/j.ajem.2020.06.085