Sinistral Portal Hypertension Prediction During Pancreatoduodenectomy With Splenic Vein Resection

Background: Pancreaticoduodenectomy with porto-mesenterico-splenic confluence resection can cause sinistral portal hypertension (SPH), which may lead to gastrointestinal bleeding. Nevertheless, it remains difficult to predict SPH development during surgery. The aim of this study is to assess the feasibility of measuring splenic vein (SV) pressure to predict SPH. Methods: The patients who underwent pancreaticoduodenectomy with porto-mesenterico-splenic confluence resection between January 2016 and December 2017 were included in this study. SV pressure was measured before SV clamping (SVP1) and after SV clamping (SVP2). SPH was defined as varicose vein formation detected by follow-up computed tomography. Incidence of SPH was assessed in patients who had no SV drainage after surgery. Results: SV pressure was measured in 41 patients. Among them, 24 had no SV drainage (13 patients had occluded SV reconstruction, and 11 had SV ligation without an attempt at reconstruction) and were included for the analysis. SPH was observed in 16 of 24 patients (67%). The median Delta SVP (SPV2-SVP1) in patients with SPH was higher than that in patients without SPH (13.5 mmHg versus 7.5 mmHg, P = 0.0237). Most patients with SVP2 >20 mmHg (12/14 [86%]) or Delta SVP >10 mmHg (10/11 [91%]) developed SPH. Conclusions: For the patients with SV resection, high SV pressure after clamping (>= 20 mmHg) and a large SV pressure difference (>= 10 mmHg) before and after clamping are feasible indication criteria for SV reconstruction to prevent SPH. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

This study demonstrates that measuring splenic vein pressure can predict sinistral portal hypertension in patients undergoing pancreaticoduodenectomy with porto-mesenterico-splenic confluence resection. For patients without splenic vein drainage after surgery, splenic vein pressure exceeding 20 mmHg after clamping and a pressure difference of more than 10 mmHg before and after clamping are feasible indicators for splenic vein reconstruction to prevent sinistral portal hypertension.