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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2023; 15(4): 674-686
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.674
Ligamentum teres hepatis as a graft for portal and/or superior mesenteric vein reconstruction: From bench to bedside
Wen-Tao Zhu, Hai-Tao Wang, Qing-Hai Guan, Fan Zhang, Chang-Xi Zhang, Feng-Ai Hu, Bao-Lei Zhao, Lei Zhou, Qiang Wei, Hai-Bin Ji, Ting-Liang Fu, Xing-Yuan Zhang, Rui-Tao Wang, Qiang-Pu Chen
Wen-Tao Zhu, Fan Zhang, Chang-Xi Zhang, Bao-Lei Zhao, Lei Zhou, Qiang Wei, Hai-Bin Ji, Xing-Yuan Zhang, Qiang-Pu Chen, Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China
Hai-Tao Wang, Department of Hepatobiliary Surgery, Binzhou Medical University Affiliated Yantai Hospital, Yantai 264110, Shandong Province, China
Qing-Hai Guan, Department of Hepatobiliary Surgery and Clinical Nutrition Center, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China
Feng-Ai Hu, Department of Clinical Medicine Laboratory, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China
Ting-Liang Fu, Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China
Rui-Tao Wang, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an 710061, Shannxi Province, China
Author contributions: Zhu WT, Wang HT and Chen QP contributed to the conception and design; Zhu WT, Wang HT, Zhao BL, Wei Q and Ji HB contributed to the analysis and interpretation; Zhu WT, Wang HT, Zhang CX, Hu FA, Guan QH, Zhang XY and Wang RT collected the data; Zhu WT, Zhou L and Fu TL wrote the article; Chen QP and Zhang F critically revised the article; Zhu WT, Wang HT, Guan QH, Zhang F, Zhang CX, Hu FA, Zhao BL, Zhou L, Wei Q, Ji HB, Zhang XY and Chen QP approved the final article; Wei Q and Ji HB completed the statistical analysis; Chen QP and Zhao BL obtained fundings; Chen QP takes overall responsibility.
Supported by the Science and Technology Research and Development Program of Shandong Province, No. 2009GGl0002047; the National Natural Science Fund, No. 81502069.
Institutional review board statement: This study was approved by the Ethics Committee of Binzhou Medical University Hospital, No. 2019-LW-023.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no related conflicts of interest to declare.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: Qiang-Pu Chen, MD, Professor, Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, No. 661 Huang He Er Road, Binzhou 256600, Shandong Province, China. drchenqiangpu@163.com
Received: December 12, 2022
Peer-review started: December 12, 2022
First decision: January 11, 2023
Revised: February 6, 2023
Accepted: March 15, 2023
Article in press: March 15, 2023
Published online: April 27, 2023
ARTICLE HIGHLIGHTS
Research background
Grafts may be required for portal vein (PV) and/or superior mesenteric vein (SMV) reconstruction during a pancreaticoduodenectomy (PD) procedure combined with PV and/or SMV resection. These grafts, including autogenous, homologous and artificial blood vessels, each have their own limitations. Therefore, it is necessary to explore more suitable grafts for PV and/or SMV reconstruction.
Research motivation
The ligamentum teres hepatis (LTH) is a fibrous remnant of the obliterated umbilical vein and can be recanalized. If the diameter and the histological characteristics of the dilated LTH tube wall are similar to the PV and SMV, and if the dilated LTH can be successfully used for PV and SMV reconstruction clinically, a novel PV and SMV graft will be acquired that has many sources, no additional medical costs and no immune rejection response.
Research objectives
To evaluate the feasibility of using the LTH as an autologous substitute for the reconstruction of the PV and/or SMV during PD and to provide basic and clinical evidence for using the LTH as an autologous graft for the PV and/or SMV reconstruction.
Research methods
The dilated length, diameter, tube wall histological characteristics and endothelial cell function of the LTH were measured and observed, and the results were compared to the PV and SMV for the first time. The outcomes of 26 patients who underwent PD where the LTH was used for PV and/or SMV reconstruction were studied, which is the largest sample size to date that exclusively focused on patients with venous reconstruction using a recanalized LTH graft during PD. The patency of the reconstructed PV and/or SMV using LTH as the autologous graft was reported for the first time.
Research results
The length, diameter and histological characteristics of the LTH tube wall were similar to the PV and/or SMV. The tunica intima of the LTH was covered with endothelial cells, and these cells functioned normally. The LTH as an autologous graft for PV and/or SMV reconstruction was successfully used in the clinic. However, larger prospective studies should be conducted in the future to validate the findings of this study.
Research conclusions
The LTH can be used as an autologous graft for PV and/or SMV reconstruction.
Research perspectives
The establishment of a homologous blood vessel bank using the LTH as grafts is expected.
