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European Journal of Radiology Mar 2018Neurofibroblastoma (NF) or Von Recklinghausen disease, is an autosomal dominant disorder affecting one in 3000 individuals. Cardinal features of NF include multiple... (Review)
Review
BACKGROUND
Neurofibroblastoma (NF) or Von Recklinghausen disease, is an autosomal dominant disorder affecting one in 3000 individuals. Cardinal features of NF include multiple café-au-lait macules, benign neurofibromas, and iris hamartomas. Albeit less common, vascular lesions of medium and large-sized arteries and veins are a well-recognized complication, which can lead to fatal consequences such as rupture.
METHOD
A systematic review was conducted as per the Preferred Reporting Instructions for Systematic Reviews and Meta-analysis (PRISMA) guidelines utilizing PubMed, EMBASE, and Cochrane databases.
RESULTS
There were 59 articles identified involving 66 patients (mean age 44.3 ± 30 years), of which 89% had neurofibromatosis type 1. There were 63.6% of patients who presented with aneurysm rupture, 33.3% presented with intact symptomatic aneurysms, and 3.1% presented with intact asymptomatic aneurysms. Anatomically, 4.5% of patients suffered from intracranial aneurysms; 12.1% suffered from visceral artery aneurysms (including hepatic, superior mesenteric, gastroduodenal and renal arteries), and other patients suffered from aneurysms within the chest, abdomen, pelvis, upper limbs and neck. Amongst the various endovascular procedures, coiling was performed in 83.3% of cases. There were 12 covered stents employed in 10 patients (18.2%), of which 7 were balloon-expandable grafts; 2 were self-expandable graft; 3 were not mentioned. The rates of major and minor complications were 15% and 6% respectively, with 4 cases (6%) of perioperative death. On a mean follow-up of 15 months (range 1.5-72 months), two patients developed a distant vascular lesion from the treated lesion.
CONCLUSION
Endovascular management is safe and effective even in hemodynamically unstable neurofibroblastoma patients at all ages. Vascular tree screening should be conducted in clinically suspicious patients to prevent fatal aneurysmal complications. A formal meta-analysis could not be performed due to the lack of randomized controlled trials.
Topics: Adolescent; Adult; Aged; Aneurysm; Endovascular Procedures; Female; Humans; Male; Middle Aged; Neurofibromatosis 1; Treatment Outcome; Young Adult
PubMed: 29496081
DOI: 10.1016/j.ejrad.2017.12.014 -
Journal of Gastrointestinal Surgery :... May 2018Mesopancreas dissection with central vascular ligation and the superior mesenteric artery (SMA)-first approach represent the cornerstone of current principles for... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Mesopancreas dissection with central vascular ligation and the superior mesenteric artery (SMA)-first approach represent the cornerstone of current principles for radical resection for pancreatic head cancer. The surgeon dissecting around the SMV and SMA should be aware regarding the anatomical variants in this area. The aims of this systematic review and meta-analysis are to detail the surgical anatomy of the superior mesenteric vessels and to propose a standardized terminology with impact in pancreatic cancer surgery.
METHODS
We conducted a systematic search to identify all published studies in PubMed/MEDLINE and Google Scholar databases from their inception up to March 2017.
RESULTS
Seventy-eight studies, involving a total of 18,369 specimens, were included. The prevalence of the mesenteric-celiac trunk, replaced/accessory right hepatic artery (RRHA), common hepatic artery, and SMV inversion was 2.8, 13.2, 2.6, and 4.1%, respectively. The inferior pancreaticoduodenal artery has its origin into the first jejunal artery, SMA, and RRHA, in 58.7, 35.8, and 1.2% of cases, respectively. The SMV lacks a common trunk in 7.5% of cases. The first jejunal vein has a trajectory posterior to the SMA in 71.8% of cases. The left gastric vein drains into the portal vein in 58%, in splenic vein (SV) in 35.6%, and into the SV-PV confluence in 5.8% of cases.
CONCLUSIONS
Complex pancreaticoduodenal resections require detailed knowledge of the superior mesenteric artery and vein, which is significantly different from the one presented in the classical textbooks of surgery. We are proposing the concept of the first jejunopancreatic vein which impacts the current oncological principles of pancreatic head cancer resection.
Topics: Celiac Artery; Dissection; Hepatic Artery; Humans; Mesenteric Artery, Superior; Mesenteric Veins; Pancreas; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein; Splenic Vein
PubMed: 29363018
DOI: 10.1007/s11605-018-3669-1 -
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 -
Surgery For Obesity and Related... Jan 2018Portomesenteric and splenic vein thrombosis (PMSVT) is a rare but potentially serious complication after bariatric surgery. No study has systematically analyzed its... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Portomesenteric and splenic vein thrombosis (PMSVT) is a rare but potentially serious complication after bariatric surgery. No study has systematically analyzed its incidence and risk factors.
OBJECTIVES
To pool the data regarding PMSVT after bariatric surgery and determine its incidence and risk factors.
METHODS
A meta-analysis and systematic review was conducted to retrieve studies on PMSVT after bariatric surgery.
RESULTS
A total of 41 eligible studies including 110 patients with postbariatric PMSVT were enrolled; the estimated incidence rate based on 13 studies was .4%. The use of oral contraception was reported in 35.4% of patients, previous surgery in 61.1%, smoking in 37.2%, and history of coagulopathy in 43%. PMSVT mostly occurred after sleeve gastrectomy (78.9%) and within the first postoperative month (88.9%). Pneumoperitoneum pressure was>15 mm Hg in 6% of patients. The portal vein was the most commonly affected vessel (41.5%). Prothrombin 20210 mutation and protein C/S deficiency were the most common thrombophilic conditions. Unfractionated heparin (59.1%), vitamin K antagonists (50.9%), and low molecular weight heparin (39.1%) were the most common treatments for PMSVT. The morbidity and mortality rates for postbariatric PMSVT were 8.2% and 3.6%, respectively.
CONCLUSION
PMSVT usually occurs within the first postoperative month and is mostly reported after sleeve gastrectomy. The portal vein is the most commonly involved vessel. A previous hypercoagulable state can be an important risk factor. Most patients can be treated with anticoagulation therapy. Further studies with comprehensive data review of patient information are required.
Topics: Adult; Anticoagulants; Bariatric Surgery; Blood Coagulation Disorders; Contraceptives, Oral; Female; Humans; Male; Mesenteric Veins; Middle Aged; Obesity, Morbid; Portal Vein; Postoperative Complications; Risk Factors; Smoking; Venous Thrombosis
PubMed: 29111221
DOI: 10.1016/j.soard.2017.09.512 -
Surgery For Obesity and Related... Aug 2017Portomesenteric vein thrombosis (PMVT) is considered an uncommon complication in general surgery; nevertheless, with the growing popularity of sleeve gastrectomy (SG) as... (Review)
Review
BACKGROUND
Portomesenteric vein thrombosis (PMVT) is considered an uncommon complication in general surgery; nevertheless, with the growing popularity of sleeve gastrectomy (SG) as a bariatric procedure we have seen an increase in the occurrence of this complication.
OBJECTIVES
To elucidate the question if it is a procedure-related complication and explore the modalities of prevention and treatment of this complication, a systematic review of available literature regarding PMVT events after SG was conducted.
METHODS
Our systematic review yielded 28 studies enclosing 89 patients. Perioperative data was collected from each study and analyzed.
RESULTS
The incidence of PMVT after SG ranged from .37% to 1%, 65% of the patients were female, and the mean body mass index was 41.63 kg/m. Perioperative co-morbidities including hypertension, diabetes, and dyslipidemia were recorded in 39.7%, 41.63%, and 38.23% of cases respectively. Tachycardia and fever were reported only in 23.9% and 20.89%, respectively, and hereditary thrombophilia studies were positive in 30.43% of cases. The rate of acute major complications after PMVT was 14.6% (13 cases), and mortality was reported in 3 cases (average 3.37%).
CONCLUSION
PMVT seems to be an uncommon multifactorial disease, with unpredictable symptoms and varieties of the treatments options, but additional studies are required to further define optimal management and prevention algorithms.
Topics: Bariatric Surgery; Gastrectomy; Humans; Mesenteric Ischemia; Mesenteric Veins; Portal Vein; Postoperative Complications; Thrombophilia; Venous Thrombosis
PubMed: 28526434
DOI: 10.1016/j.soard.2017.03.015 -
Oncotarget May 2017The impact of histopathologic tumor invasion of the superior mesenteric vein (SMV)/portal vein (PV) on prognosis in patients with pancreatic ductal adenocarcinoma (PDAC)... (Meta-Analysis)
Meta-Analysis Review
Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis.
BACKGROUND
The impact of histopathologic tumor invasion of the superior mesenteric vein (SMV)/portal vein (PV) on prognosis in patients with pancreatic ductal adenocarcinoma (PDAC) after pancreatectomy remains controversial. A meta-analysis was performed to assess this issue.
RESULTS
Eighteen observational studies comprising 5242 patients were eligible, of whom 2199 (41.9%) patients received SMV/PV resection. Histopathologic tumor invasion was detected in 1218 (58.1%) of the 2096 resected SMV/PV specimens. SMV/PV invasion was associated with higher rates of poor tumor differentiation (P = 0.002), lymph node metastasis (P < 0.001), perineural invasion (P < 0.001), positive resection margins (P = 0.004), and postoperative tumor recurrence (P < 0.001). SMV/PV invasion showed a significantly negative effect on survival in total patients who underwent pancreatectomy with and without SMV/PV resection (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 1.08-1.35; P = 0.001) and in patients who underwent pancreatectomy with SMV/PV resection (HR: 1.88, 95% CI, 1.48-2.39; P < 0.001).
MATERIALS AND METHODS
A systematic literature search was performed to identify articles published from January 2000 to August 2016. Data were pooled for meta-analysis using Review Manager 5.3.
CONCLUSIONS
Histopathologic tumor invasion of the SMV/PV is associated with more aggressive biologic behavior and could be used as an indicator of poor prognosis after PDAC resection.
Topics: Carcinoma, Pancreatic Ductal; Female; Humans; Male; Mesenteric Veins; Prognosis; Retrospective Studies; Survival Analysis
PubMed: 28427231
DOI: 10.18632/oncotarget.15938 -
Langenbeck's Archives of Surgery Dec 2016This study aims to define the current status of robotic pancreatoduodenectomy (RPD) with resection and reconstruction of the superior mesenteric/portal vein (RPD-SMV/PV). (Review)
Review
PURPOSE
This study aims to define the current status of robotic pancreatoduodenectomy (RPD) with resection and reconstruction of the superior mesenteric/portal vein (RPD-SMV/PV).
METHODS
Our experience on RPD, including RPD-SMV/PV, is presented along with a description of the surgical technique and a systematic review of the literature on RPD-SMV/PV.
RESULTS
We have performed 116 RPD and 14 RPD-SMV/PV. Seven additional cases of RPD-SMV/PV were identified in the literature. In our experience, RPD and RPD-SMV/PV were similar in all baseline variables, but lower mean body mass and higher prevalence of pancreatic cancer in RPD-SMV/PV. Regarding the type of vein resection, there were one type 2 (7.1 %), five type 3 (35.7 %) and eight type 4 (57.2 %) resections. As compared to RPD, RPD-SMV/PV required longer operative time, had higher median estimated blood loss, and blood transfusions were required more frequently. Incidence and severity of post-operative complications were not increased in RPD-SMV/PV, but post-pancreatectomy hemorrhage occurred more frequently after this procedure. In pancreatic cancer, RPD-SMV/PV was associated with a higher mean number of examined lymph nodes (60.0 ± 13.9 vs 44.6 ± 11.0; p = 0.02) and with the same rate of microscopic margin positivity (25.0 % vs 26.1 %). Mean length or resected vein was 23.1 ± 8.08 mm. Actual tumour infiltration was discovered in ten patients (71.4 %), reaching the adventitia in four patients (40.0 %), the media in two patients (20.0 %), and the intima in four patients (40.0 %). Literature review identified seven additional cases, all reported to have successful outcome.
CONCLUSIONS
RPD-SMV/PV is feasible in carefully selected patients. The generalization of these results remains to be demonstrated.
Topics: Humans; Mesenteric Veins; Pancreaticoduodenectomy; Portal Vein; Robotic Surgical Procedures
PubMed: 27553112
DOI: 10.1007/s00423-016-1499-8 -
Colorectal Disease : the Official... Jul 2015The primary aim of this study was to determine whether the in-hospital mortality for acute mesenteric infarction has reduced in the last decade. The secondary aim was to... (Meta-Analysis)
Meta-Analysis Review
AIM
The primary aim of this study was to determine whether the in-hospital mortality for acute mesenteric infarction has reduced in the last decade. The secondary aim was to determine if there was a statistical difference in mortality between patients having acute primary mesenteric infarction due to different causes.
METHOD
A literature search was performed of PubMed, Ovid (Embase) and Google Scholar databases. Studies on acute mesenteric infarction of primary vascular pathology were included for pooled analyses while studies that had reported comparative mortality between arterial, venous and non-occlusive mesenteric infarction (NOMI) were included in meta-analyses. Their quality was assessed using the National Institute for Health and Care Excellence assessment scale. Odds ratios (ORs) of mortality were calculated using a Mantel-Haenszel random effect model.
RESULTS
The total number of patients was 4527 and the male/female ratio was 1912/2247. The pooled in-hospital mortality was 63%. There was no significant reduction of in-hospital mortality rate in the last decade (P = 0.78). There was a significant difference in in-hospital mortality between acute arterial mesenteric infarction (73.9%) compared with acute venous mesenteric infarction (41.7%) [OR 3.47, confidence interval (CI) 2.43-4.96, P < 0.001] and NOMI (68.5%) compared with acute venous mesenteric infarction (44.2%) (OR 3.2, CI 1.83-5.6, P < 0.001). There was no difference in mortality between acute arterial mesenteric infarction and NOMI (OR 1.08, CI 0.57-2.03, P = 0.82).
CONCLUSION
In-hospital mortality rate has not changed in the last decade. Patients with arterial mesenteric infarction or with NOMI are over three times more likely to die during the first hospital admission compared with those with venous mesenteric infarction.
Topics: Acute Disease; Female; Hospital Mortality; Humans; Infarction; Intestines; Male; Mesenteric Arteries; Mesenteric Ischemia; Mesenteric Veins; Mesentery; Observational Studies as Topic
PubMed: 25739990
DOI: 10.1111/codi.12938 -
Pancreas Oct 2014Portal annular pancreas (PAP) is an asymptomatic congenital pancreas anomaly, in which portal and/or mesenteric veins are encased by pancreas tissue. The aim of the... (Review)
Review
Portal annular pancreas (PAP) is an asymptomatic congenital pancreas anomaly, in which portal and/or mesenteric veins are encased by pancreas tissue. The aim of the study was to determine the role of PAP in pancreatic surgery as well as its management and potential complication, specifically, postoperative pancreatic fistula (POPF).On the basis of a case report, the MEDLINE and ISI Web of Science databases were systematically reviewed up to September 2012. All articles describing a case of PAP were considered.In summary, 21 studies with 59 cases were included. The overall prevalence of PAP was 2.4% and the patients' mean (SD) age was 55.9 (16.2) years. The POPF rate in patients with PAP (12 pancreaticoduodenectomies and 3 distal pancreatectomies) was 46.7% (in accordance with the definition of the International Study Group of Pancreatic Surgery).Portal annular pancreas is a quite unattended pancreatic variant with high prevalence and therefore still remains a clinical challenge to avoid postoperative complications. To decrease the risk for POPF, attentive preoperative diagnostics should also focus on PAP. In pancreaticoduodenectomy, a shift of the resection plane to the pancreas tail should be considered; in extensive pancreatectomy, coverage of the pancreatic remnant by the falciform ligament could be a treatment option.
Topics: Adrenal Gland Neoplasms; Delayed Diagnosis; Disease Management; Female; Humans; Incidental Findings; Infant, Newborn; Male; Middle Aged; Pancreas; Pancreatectomy; Pancreatic Diseases; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Complications; Prevalence; Sex Distribution
PubMed: 25207658
DOI: 10.1097/MPA.0000000000000186