Zhao D, Huang YM, Liang ZM, Zhang KJ, Fang TS, Yan X, Jin X, Zhang Y, Tang JX, Xie LJ, Zeng XC. Reconstructing the portal vein through a posterior pancreatic tunnel: New choice for portal vein thrombosis during liver transplantation. World J Gastrointest Surg 2022; 14(10): 1131-1140 [PMID: 36386397 DOI: 10.4240/wjgs.v14.i10.1131]
Corresponding Author of This Article
Dong Zhao, MD, Professor, Surgeon, Department of Liver Surgery and Organ Transplantation Center, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, No. 29 Bulan Road, Longgang District, Shenzhen 518000, Guangdong Province, China. zdong1233@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dong Zhao, Yi-Ming Huang, Zi-Ming Liang, Kang-Jun Zhang, Tai-Shi Fang, Xu Yan, Xin Jin, Yi Zhang, Jian-Xin Tang, Lin-Jie Xie, Xin-Chen Zeng, Department of Liver Surgery and Organ Transplantation Center, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen 518000, Guangdong Province, China
Author contributions: Zhao D and Huang YM were involved in the conception and design of this study; Zhao D provided administrative support in this study; Tang JX, Zhang KJ, Fang TS, and Zeng XC contributed to the provision of study materials or patients; Liang ZM, Yan X, Jin X, and Xie LJ were involved in the collection and assembly of data; Zhang Y and Huang YM analysed and interpreted the data; and all authors approved this manuscript to publish.
Supported bythe Third People’s Hospital of Shenzhen Scientific Research Project, No. G2021008 and No. G2022008; Shenzhen Key Medical Discipline Construction Fund, No. SZXK079; Shenzhen Science and Technology Research and Development Fund, No. JCYJ20190809165813331 and No. JCYJ20210324131809027.
Institutional review board statement: The study was reviewed and approved by the Third People’s Hospital of Shenzhen Institutional Review Board (Approval No. 2022-037-02).
Informed consent statement: All cases involved in this study proved written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Zhao, MD, Professor, Surgeon, Department of Liver Surgery and Organ Transplantation Center, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, No. 29 Bulan Road, Longgang District, Shenzhen 518000, Guangdong Province, China. zdong1233@126.com
Received: July 14, 2022 Peer-review started: July 14, 2022 First decision: July 31, 2022 Revised: August 8, 2022 Accepted: September 21, 2022 Article in press: September 21, 2022 Published online: October 27, 2022 Processing time: 102 Days and 21.9 Hours
Abstract
BACKGROUND
Thrombectomy and anatomical anastomosis (TAA) has long been considered the optimal approach to portal vein thrombosis (PVT) in liver transplantation (LT). However, TAA and the current approach for non-physiological portal reconstructions are associated with a higher rate of complications and mortality in some cases.
AIM
To describe a new choice for reconstructing the portal vein through a posterior pancreatic tunnel (RPVPPT) to address cases of unresectable PVT.
METHODS
Between August 2019 and August 2021, 245 adult LTs were performed. Forty-five (18.4%) patients were confirmed to have PVT before surgery, among which seven underwent PV reconstruction via the RPVPPT approach. We retrospectively analyzed the surgical procedure and postoperative complications of these seven recipients that underwent PV reconstruction due to PVT.
RESULTS
During the procedure, PVT was found in all the seven cases with significant adhesion to the vascular wall and could not be dissected. The portal vein proximal to the superior mesenteric vein was damaged in one case when attempting thrombolectomy, resulting in massive bleeding. LT was successfully performed in all patients with a mean duration of 585 min (range 491-756 min) and mean intraoperative blood loss of 800 mL (range 500-3000 mL). Postoperative complications consisted of chylous leakage (n = 3), insufficient portal venous flow to the graft (n = 1), intra-abdominal hemorrhage (n = 1), pulmonary infection (n = 1), and perioperative death (n = 1). The remaining six patients survived at 12-17 mo follow-up.
CONCLUSION
The RPVPPT technique might be a safe and effective surgical procedure during LT for complex PVT. However, follow-up studies with large samples are still warranted due to the relatively small number of cases.
Core Tip: In the study, we presented a new choice for reconstructing the portal vein through a posterior pancreatic tunnel (RPVPPT) to address the issue of unresectable portal vein thrombosis in adult liver transplantation (LT). Clinical data of seven recipients who had portal vein thrombosis (PVT) and underwent RPVPPT were analyzed. PVT was found in all the seven cases with significant adhesion to the vascular wall and could not be dissected. LT was successfully performed in all patients without serious complications. Six patients survived at 12-17 mo follow-up. The RPVPPT technique may be a safe and effective surgical procedure in LT for complex PVT.
