Published online Oct 27, 2022. doi: 10.4240/wjgs.v14.i10.1131
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
Portal vein thrombosis (PVT) poses a great challenge in liver transplantation (LT). It has been established that thrombectomy and anatomical anastomosis (TAA) can restore the physiological anatomy of the portal vein by complete thrombus excision and has been considered the optimal solution to this problem; however, in some cases, PVT cannot be treated by TAA.
We describe our experience of reconstructing the portal vein through a posterior pancreatic tunnel (RPVPPT) to address the issue of unresectable PVT, which may achieve a similar effect to TAA and provide a new approach to solve this intricate clinical problem.
We sought to describe a new strategy of RPVPPT to address cases of unresectable PVT.
A retrospective analysis was performed on 245 adult patients that underwent LT from August 2019 to August 2021. Forty-five (18.4%) patients presented with PVT before surgery, among which seven underwent portal vein reconstruction using RPVPPT. Preoperative clinical data, operation-related indicators, and postoperative complications were statistically analyzed.
During the operation, PVT was found in all seven cases with significant adhesion to the vascular wall and could not be dissected. LT was successfully performed in all patients without serious postoperative complications. At 12-17 mo follow-up, there were six patients who survived.
The RPVPPT technique can restore the physiological anatomy of the portal vein system through a retropancreatic tunnel, which might be a safe and effective surgical procedure in LT for complex PVT.
Due to the relatively small number of cases in the study, follow-up studies with large samples are still required.