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Langenbeck's Archives of Surgery Feb 2022We designed a retrospective computational study to evaluate the effects of hemodynamics on portal confluence remodeling in real models of patients with malignancies of...
Hemodynamics and remodeling of the portal confluence in patients with malignancies of the pancreatic head: a pilot study towards planned and circumferential vein resections.
BACKGROUND
We designed a retrospective computational study to evaluate the effects of hemodynamics on portal confluence remodeling in real models of patients with malignancies of the pancreatic head.
METHODS
Patient-specific models were created according to computed tomography data. Fluid dynamics was simulated by using finite-element methods. Computational results were compared to morphological findings.
RESULTS
Five patients underwent total pancreatectomy, one had duodenopancreatectomy. Vein resection was performed en-bloc with the specimen. Histopathological findings showed that in patients without a vein stenosis and a normal hemodynamics, the three-layered wall of the vein was preserved. In patients with a stenosis > 70% of vein diameter and modified hemodynamics, the three-layered structure of the resected vein was replaced by a dense inflammatory infiltrate in absence of tumor infiltration.
CONCLUSIONS
The portal confluence involved by malignancies of the pancreatic head undergoes a remodeling that is not mainly due to a wall infiltration by the tumor but instead to a persistent pathological hemodynamics that disrupts the balance between eutrophic remodeling and degradative process of the vein wall that can lead to the complete upheaval of the three-layered vein wall. This finding can have useful surgical application in planning resection of the vein involved by tumor growth.
Topics: Hemodynamics; Humans; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Pilot Projects; Portal Vein; Retrospective Studies
PubMed: 34432127
DOI: 10.1007/s00423-021-02309-3 -
Clinical Gastroenterology and... Apr 2022
Topics: Abdomen; Emphysema; Gastritis; Humans; Intraabdominal Infections; Portal Vein
PubMed: 33866008
DOI: 10.1016/j.cgh.2021.04.020 -
Cardiorenal Medicine 2021Optimal method for noninvasive assessment of venous congestion remains an unresolved issue. Portal vein (PV) and intrarenal venous flow alterations are markers of...
INTRODUCTION
Optimal method for noninvasive assessment of venous congestion remains an unresolved issue. Portal vein (PV) and intrarenal venous flow alterations are markers of abdominal venous congestion and have been associated with acute kidney injury (AKI) in cardiac surgery patients. It is currently unknown if portal vein flow (PVF) alterations in heart failure can be reversed with diuretic treatment and track decongestion.
OBJECTIVE
The aim of this study is to evaluate PVF alterations in patients with ADHF at arrival and after decongestive treatment.
METHODS
Assessment of venous congestion using point-of-care ultrasound was performed in 12 patients with ADHF (6 patients with left-sided heart failure and 6 patients with right-sided heart failure). Evaluation included inferior vena cava (IVC) size and collapsibility in addition to PV Doppler to determine pulsatility fraction (PF).
RESULTS
Increased PV PF (81.75 ± 13%) was found on admission. After effective decongestive treatment, it improved to (17.43 ± 2.2%). Improvement in IVC size and collapsibility was seen in most patients with left-sided heart failure and none of the patients with right-sided heart failure. Improvement in PV PF coincided with return to baseline of Serum Cr in patients that presented with AKI.
CONCLUSIONS
Evaluation of abdominal venous congestion by point-of-care ultrasound could aid in diagnosis and follow-up of patients with congestive kidney injury.
Topics: Cardiac Surgical Procedures; Cardio-Renal Syndrome; Heart Failure; Humans; Portal Vein; Ultrasonography
PubMed: 33477157
DOI: 10.1159/000511714 -
World Journal of Gastroenterology Aug 2022For patients with portal hypertension (PH), portal vein thrombosis (PVT) is a fatal complication after splenectomy. Postoperative platelet elevation is considered the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
For patients with portal hypertension (PH), portal vein thrombosis (PVT) is a fatal complication after splenectomy. Postoperative platelet elevation is considered the foremost reason for PVT. However, the value of postoperative platelet elevation rate (PPER) in predicting PVT has never been studied.
AIM
To investigate the predictive value of PPER for PVT and establish PPER-based prediction models to early identify individuals at high risk of PVT after splenectomy.
METHODS
We retrospectively reviewed 483 patients with PH related to hepatitis B virus who underwent splenectomy between July 2011 and September 2018, and they were randomized into either a training ( = 338) or a validation ( = 145) cohort. The generalized linear (GL) method, least absolute shrinkage and selection operator (LASSO), and random forest (RF) were used to construct models. The receiver operating characteristic curves (ROC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were used to evaluate the robustness and clinical practicability of the GL model (GLM), LASSO model (LSM), and RF model (RFM).
RESULTS
Multivariate analysis exhibited that the first and third days for PPER (PPER1, PPER3) were strongly associated with PVT [odds ratio (OR): 1.78, 95% confidence interval (CI): 1.24-2.62, = 0.002; OR: 1.43, 95%CI: 1.16-1.77, < 0.001, respectively]. The areas under the ROC curves of the GLM, LSM, and RFM in the training cohort were 0.83 (95%CI: 0.79-0.88), 0.84 (95%CI: 0.79-0.88), and 0.84 (95%CI: 0.79-0.88), respectively; and were 0.77 (95%CI: 0.69-0.85), 0.83 (95%CI: 0.76-0.90), and 0.78 (95%CI: 0.70-0.85) in the validation cohort, respectively. The calibration curves showed satisfactory agreement between prediction by models and actual observation. DCA and CIC indicated that all models conferred high clinical net benefits.
CONCLUSION
PPER1 and PPER3 are effective indicators for postoperative prediction of PVT. We have successfully developed PPER-based practical models to accurately predict PVT, which would conveniently help clinicians rapidly differentiate individuals at high risk of PVT, and thus guide the adoption of timely interventions.
Topics: Humans; Hypertension, Portal; Liver Cirrhosis; Machine Learning; Portal Vein; Retrospective Studies; Risk Factors; Splenectomy; Venous Thrombosis
PubMed: 36157936
DOI: 10.3748/wjg.v28.i32.4681 -
Surgical Endoscopy Jul 2024The right intersectional plane and the right hepatic hilum were noted too often exhibit anatomical variations, making difficult the laparoscopic right anterior...
INTRODUCTION
The right intersectional plane and the right hepatic hilum were noted too often exhibit anatomical variations, making difficult the laparoscopic right anterior sectionectomy (LRAS).
METHODS
We analyzed the anatomical features employing 3D-CT images of 55 patients, and evaluated these features according to the course of ventral branches of segment VI of the portal vein (PV, P6a) relative to the right hepatic vein (RHV).
RESULTS
P6a run on the dorsal side of RHV in 32 patients (58%, Dorsal-P6a) and the ventral side of RHV in 23 (42%, Ventral-P6a). Ventral-P6a had more patients with S6 partially drained by middle hepatic vein (MHV, 39% vs. 0%, P < 0001), the narrower angle between the anterior and posterior branches of PV (73.1° vs. 93.8°, P = 0.006), the wider angle between the RHV and inferior vena cava (54.3° vs. 44.3°, P < 0.001), and more steeply pitched angle between S6 and S7 along the RHV (140.6° vs. 162.0°, P < 0.001) compared to Dorsal-P6a.
CONCLUSION
In LRAS for Dorsal-P6a patients, the transection surface was relatively flat. In LRAS for Ventral-P6a patients, the narrow space between anterior and posterior glissons makes difficult the glissonean approach. The transection plane was steeply pitched, and RHV was partially exposed. S6 was often partially drained to MHV in 39% of the Ventral-P6a patients, which triggers congestion during liver transection of a right intersectional plane after first splitting the confluence of this branch.
Topics: Humans; Portal Vein; Female; Hepatic Veins; Male; Laparoscopy; Middle Aged; Hepatectomy; Tomography, X-Ray Computed; Aged; Imaging, Three-Dimensional; Adult; Retrospective Studies
PubMed: 38862823
DOI: 10.1007/s00464-024-10973-x -
Transplantation Proceedings Mar 2022To evaluate the significance of portosystemic shunts and associated long-term outcomes in living donor liver transplant (LDLT) among pediatric patients.
BACKGROUND
To evaluate the significance of portosystemic shunts and associated long-term outcomes in living donor liver transplant (LDLT) among pediatric patients.
METHODS
Retrospective review of 121 pediatric patients who underwent LDLT between May 1994 and December 2015 at Taiwan Kaohsiung Chang Gung Memorial Hospital. Pre- and postoperative computed tomography images of the liver were reviewed, and portal vein complications were assessed.
RESULTS
Ninety-seven pediatric patients were included in the study, and 70 had portosystemic shunts before transplant. Thirty-three patients have portal systemic shunt (PSS) 6 months after transplant (mean [SD] shunt size, 4.59 [1.98] mm). Thirty-seven patients' portosystemic shunts closed spontaneously (mean [SD] shunt size, 3.14 [1.06] mm). Smaller PSSs tend to close spontaneously with a cutoff point of 3.35 mm by receiver operating characteristic curve (P = .01). Patients with PSS have more portal vein complications than those without PSS (44.3% vs 11.1%, P = .02). Among PSS recipients, patients with portal vein complications tend to have larger PSS size (mean [SD], 4.14 [1.96] mm vs 3.59 [1.48] mm), although the difference is not statistically significant (P = .19).
CONCLUSIONS
In pediatric patients, preoperative portosystemic shunts are significantly correlated with portal venous complications, some of which require minimal interventions after LDLT with good outcomes. Shunts larger than 3.35 mm tend to persist after transplant with increased portal venous complications.
Topics: Child; Humans; Liver Transplantation; Living Donors; Portal Vein; Portasystemic Shunt, Surgical; Portasystemic Shunt, Transjugular Intrahepatic; Retrospective Studies
PubMed: 35022136
DOI: 10.1016/j.transproceed.2021.09.072 -
Journal of Gastrointestinal Surgery :... Dec 2023The liver is one the largest organs in the abdomen and the most frequent site of metastases for gastrointestinal tumors. Surgery on this complex and highly vascularized...
The liver is one the largest organs in the abdomen and the most frequent site of metastases for gastrointestinal tumors. Surgery on this complex and highly vascularized organ can be associated with high morbidity even in experienced hands. A thorough understanding of liver anatomy is key to approaching liver surgery with confidence and preventing complications. The aim of this quiz is to provide an active learning tool for a comprehensive understanding of liver anatomy and its integration into clinical practice.
Topics: Humans; Portal Vein; Liver; Abdomen; Abdominal Cavity; Hepatic Artery
PubMed: 37803180
DOI: 10.1007/s11605-023-05778-7 -
The Journal of the Association of... Jul 2023Extrahepatic portal vein obstruction (EHPVO) is a common cause of portal hypertension in India.
BACKGROUND
Extrahepatic portal vein obstruction (EHPVO) is a common cause of portal hypertension in India.
AIMS
(1) To evaluate the clinical presentation and the natural history of EHPVO; (2) to describe the risk factors, rebleeding rates and development of portal biliopathy on follow-up; and requirement of surgery in EHPVO at a tertiary care center.
METHODS
Data from 318 consecutive patients with EHPVO from June 2012 to October 2020 were analyzed. All patients underwent liver biochemistry, ultrasonography (USG) abdomen, upper gastrointestinal (GI) endoscopy, and viral serology. Color Doppler, computed tomography (CT) abdomen and magnetic resonance cholangiopancreatography (MRCP) were done as indicated.
RESULTS
Mean age of presentation was 15.08 years [standard deviation (SD) 12.74; 6 months-60 years; 210 males)]. The presenting features were upper GI bleed (n = 227) (age at first bleed 11 years; 4 months-56 years), left hypochondrium pain or lump (n = 67), and only lower GI bleed (n = 1). Incidentally detected EHPVO on USG was seen in 10.69% (n = 34) patients. Postbleed ascites were seen in 10.69% (n = 34) patients. Six patients had symptomatic portal biliopathy and 14 had hypersplenism. Around 14.77% (n = 47) of patients had a history of being delivered at home, while 3.45% (n = 11) had a history of umbilical sepsis. During follow-up, 35.3% (n = 82) of patients had rebled. On imaging, associated splenic vein (SV) collaterals and superior mesenteric vein (SMV) collaterals were seen in 35.84% (n = 114) and 11.01% (n = 35) patients, respectively. Gallbladder varices were seen in 44.3% (n = 106), while gallstones in 5.66% (n = 18). On endoscopy, 87.42% (n = 278) patients had esophageal varices, 18.86% (n = 60) had isolated fundic varices, and three had ectopic varices. Only two patients had rectal varices and colopathy. Emergency devascularization was required in 3.45% (n = 14) patients for the failure of variceal bleed control, 1.88% (n = 7) underwent splenectomy, and four patients had proximal splenorenal shunt (PSRS) surgery.
CONCLUSION
Extrahepatic portal hypertension (EHPVO) is an important cause of portal hypertension (PHT) in our country. The majority of them present with GI bleed; postbleed ascites were seen only in ~10%. Rebleed occurs in one-third of cases. Gallbladder varices were common; portal biliopathy occurred in 10% and were usually asymptomatic.
Topics: Male; Humans; Adolescent; Child; Portal Vein; Tertiary Care Centers; Ascites; Hypertension, Portal; Esophageal and Gastric Varices; Varicose Veins; Gastrointestinal Hemorrhage
PubMed: 37449688
DOI: 10.59556/japi.71.0281 -
Technology in Cancer Research &... 2022This retrospective study aimed to evaluate the technical feasibility and safety of the delayed catheter removal technique in trans-hepatic portal vein embolization...
This retrospective study aimed to evaluate the technical feasibility and safety of the delayed catheter removal technique in trans-hepatic portal vein embolization (PVE) and to explore a suitable technique. This was a retrospective study. In 278 consecutive patients, the puncture tract of the trans-hepatic PVE was treated using the delayed catheter removal technique after PVE. The existence of peripheral hepatic hematoma formation was assessed using ultrasound (US). Follow-up examinations such as magnetic resonance imaging (MRI), computed tomography (CT), and/or US were performed to evaluate perihepatic hematoma formation, hemoperitoneum, and other major complications. Instant hemostasis was achieved in all patients after the procedure. PVE-associated complications were observed in 9 patients (3.24%). No perihepatic hematoma or hemoperitoneum was found in any of the patients. With the appropriate technique, the delayed catheter removal technique can be reliably utilized as a substitute for hemostasis as it is simple and free. This technique should be further evaluated and compared with other methods. This study is the first to investigate the safety and feasibility of the delayed catheter removal technique for embolizing the puncture tract of the trans-hepatic PVE.
Topics: Catheters; Feasibility Studies; Hepatectomy; Humans; Liver Neoplasms; Portal Vein; Retrospective Studies; Treatment Outcome
PubMed: 35119340
DOI: 10.1177/15330338221075154 -
Journal of Hepato-biliary-pancreatic... Jul 2023Laparoscopic pancreaticoduodenectomy (PD) with major vein resection is a challenging procedure. Herein, we evaluated the feasibility and safety of laparoscopic vein...
BACKGROUND/PURPOSE
Laparoscopic pancreaticoduodenectomy (PD) with major vein resection is a challenging procedure. Herein, we evaluated the feasibility and safety of laparoscopic vein resection in pancreatic head cancer with portal vein/superior mesenteric vein (PV/SMV) invasion, and compared the survival rate following laparoscopic surgery with that following open surgery.
METHODS
We retrospectively reviewed the electronic medical records of all patients with pancreatic head cancer who underwent surgery performed by a single surgeon from January 2015 to December 2017. Kaplan-Meier curves were plotted to compare the disease-free survival, while Cox-proportional hazard models were used to analyze prognostic factors for survival.
RESULTS
Among 76 patients, 63 underwent open PD and 13 underwent laparoscopic PD with PV/SMV resection. There was no significant difference in the rate of complications, including portal vein stenosis and portal vein thrombus, recurrence of tumors, or pathological outcomes after surgery between the groups. There was also no significant difference in disease-free survival (p = .803) between the two groups. Additionally, the surgical method was not an independent prognostic factor for disease-free survival.
CONCLUSIONS
Laparoscopic PD with major vein resection can be feasibly performed in select patients with abutment and focal narrowing of the PV/SMV in pancreatic head cancer.
Topics: Humans; Pancreaticoduodenectomy; Treatment Outcome; Retrospective Studies; Pancreatic Neoplasms; Portal Vein; Laparoscopy
PubMed: 36740999
DOI: 10.1002/jhbp.1317