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Akio Saiura - One of the best experts on this subject based on the ideXlab platform.
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sinistral portal hypertension after pancreaticoduodenectomy with Splenic Vein ligation
British Journal of Surgery, 2015Co-Authors: Yoshihiro Ono, Kiyoshi Matsueda, Yosuke Inoue, Yu Takahashi, Toshiyuki Unno, Rintaro Koga, Junichi Arita, Michiro Takahashi, Akio SaiuraAbstract:Background Splenic Vein ligation may result in sinistral (left-sided) portal hypertension and gastrointestinal haemorrhage. The aim of this study was to analyse the pathogenesis of sinistral portal hypertension following Splenic Vein ligation in pancreaticoduodenectomy. Methods Patients who underwent pancreaticoduodenectomy for pancreatic cancer between January 2005 and December 2012 were included in this retrospective study. The venous flow pattern from the spleen and Splenic hypertrophy were examined after surgery. Results Of 103 patients who underwent pancreaticoduodenectomy with portal Vein resection, 43 had Splenic Vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose Veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater Splenic hypertrophy than the non-varicose route (median Splenic hypertrophy ratio 1·52 versus 0·94; P < 0·001). All patients with the varicose route had colonic varices, and none had a right colic marginal Vein at the hepatic flexure. Conclusion Pancreaticoduodenectomy with Splenic Vein ligation may lead to sinistral portal hypertension. To avoid the development of varices, it is important to preserve the right colic marginal Vein. Reconstruction of the Splenic Vein should be considered if the right colic marginal Vein is divided.
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Sinistral portal hypertension after pancreaticoduodenectomy with Splenic Vein ligation
The British journal of surgery, 2014Co-Authors: Yoshihiro Ono, Kiyoshi Matsueda, Yosuke Inoue, Yu Takahashi, Toshiyuki Unno, Rintaro Koga, Junichi Arita, Michiro Takahashi, Akio SaiuraAbstract:Background Splenic Vein ligation may result in sinistral (left-sided) portal hypertension and gastrointestinal haemorrhage. The aim of this study was to analyse the pathogenesis of sinistral portal hypertension following Splenic Vein ligation in pancreaticoduodenectomy. Methods Patients who underwent pancreaticoduodenectomy for pancreatic cancer between January 2005 and December 2012 were included in this retrospective study. The venous flow pattern from the spleen and Splenic hypertrophy were examined after surgery. Results Of 103 patients who underwent pancreaticoduodenectomy with portal Vein resection, 43 had Splenic Vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose Veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater Splenic hypertrophy than the non-varicose route (median Splenic hypertrophy ratio 1·52 versus 0·94; P
Toshiyuki Unno - One of the best experts on this subject based on the ideXlab platform.
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Impact of portal Vein resection with Splenic Vein reconstruction after pancreatoduodenectomy on sinistral portal hypertension: Who needs reconstruction?
Surgery, 2018Co-Authors: Masayuki Tanaka, Hiromichi Ito, Yoshihiro Ono, Kiyoshi Matsueda, Yoshihiro Mise, Takeaki Ishizawa, Yosuke Inoue, Yu Takahashi, Makiko Hiratsuka, Toshiyuki UnnoAbstract:Background Resection of the porto-mesenterico-Splenic confluence is at times necessary during pancreatoduodenectomy with portal Vein resection for pancreatic cancer. Although Splenic Vein ligation can cause sinistral portal hypertension, the incidence of clinically relevant sinistral portal hypertension remains unknown, and the roles of the preservation of potential collateral Veins and Splenic Vein reconstruction are controversial. Methods Patients with pancreatic cancer who underwent pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection were assessed for incidence of development of varices by computed tomography at 6 months after pancreatoduodenectomy. We evaluated the risk factors for sinistral portal hypertension and the impact of Splenic Vein reconstruction on sinistral portal hypertension. Results Of the 118 patients who underwent pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection, 31 (26%) underwent Splenic Vein reconstruction, 44 patients (37%) developed gastroesophageal varices, and 5 (11%) experienced varix rupture. Sacrifice of all 3 potential collateral Veins (what we refer to as the critical Veins: left gastric Vein, middle colic Vein, and superior right colic Vein arcade) and absence of any spontaneous splenorenal shunt had a substantial impact on formation of varices. The risk of variceal formation could be stratified based on the number of preserved critical Veins, and patent Splenic Vein reconstruction was associated with a decreased incidence of varices (60% versus 100%, P = .018) among the patients without preservation of the critical Veins. In contrast, patients with multiple intact critical Veins developed no varices, regardless of Splenic Vein reconstruction. Conclusions Sinistral portal hypertension is not uncommon after pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection, and the number of preserved critical Veins helps to predict the risk of sinistral portal hypertension. Thus, the indication for Splenic Vein reconstruction should be tailored according to individual risk factors.
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sinistral portal hypertension after pancreaticoduodenectomy with Splenic Vein ligation
British Journal of Surgery, 2015Co-Authors: Yoshihiro Ono, Kiyoshi Matsueda, Yosuke Inoue, Yu Takahashi, Toshiyuki Unno, Rintaro Koga, Junichi Arita, Michiro Takahashi, Akio SaiuraAbstract:Background Splenic Vein ligation may result in sinistral (left-sided) portal hypertension and gastrointestinal haemorrhage. The aim of this study was to analyse the pathogenesis of sinistral portal hypertension following Splenic Vein ligation in pancreaticoduodenectomy. Methods Patients who underwent pancreaticoduodenectomy for pancreatic cancer between January 2005 and December 2012 were included in this retrospective study. The venous flow pattern from the spleen and Splenic hypertrophy were examined after surgery. Results Of 103 patients who underwent pancreaticoduodenectomy with portal Vein resection, 43 had Splenic Vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose Veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater Splenic hypertrophy than the non-varicose route (median Splenic hypertrophy ratio 1·52 versus 0·94; P < 0·001). All patients with the varicose route had colonic varices, and none had a right colic marginal Vein at the hepatic flexure. Conclusion Pancreaticoduodenectomy with Splenic Vein ligation may lead to sinistral portal hypertension. To avoid the development of varices, it is important to preserve the right colic marginal Vein. Reconstruction of the Splenic Vein should be considered if the right colic marginal Vein is divided.
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Sinistral portal hypertension after pancreaticoduodenectomy with Splenic Vein ligation
The British journal of surgery, 2014Co-Authors: Yoshihiro Ono, Kiyoshi Matsueda, Yosuke Inoue, Yu Takahashi, Toshiyuki Unno, Rintaro Koga, Junichi Arita, Michiro Takahashi, Akio SaiuraAbstract:Background Splenic Vein ligation may result in sinistral (left-sided) portal hypertension and gastrointestinal haemorrhage. The aim of this study was to analyse the pathogenesis of sinistral portal hypertension following Splenic Vein ligation in pancreaticoduodenectomy. Methods Patients who underwent pancreaticoduodenectomy for pancreatic cancer between January 2005 and December 2012 were included in this retrospective study. The venous flow pattern from the spleen and Splenic hypertrophy were examined after surgery. Results Of 103 patients who underwent pancreaticoduodenectomy with portal Vein resection, 43 had Splenic Vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose Veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater Splenic hypertrophy than the non-varicose route (median Splenic hypertrophy ratio 1·52 versus 0·94; P
Yoshihiro Ono - One of the best experts on this subject based on the ideXlab platform.
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Impact of portal Vein resection with Splenic Vein reconstruction after pancreatoduodenectomy on sinistral portal hypertension: Who needs reconstruction?
Surgery, 2018Co-Authors: Masayuki Tanaka, Hiromichi Ito, Yoshihiro Ono, Kiyoshi Matsueda, Yoshihiro Mise, Takeaki Ishizawa, Yosuke Inoue, Yu Takahashi, Makiko Hiratsuka, Toshiyuki UnnoAbstract:Background Resection of the porto-mesenterico-Splenic confluence is at times necessary during pancreatoduodenectomy with portal Vein resection for pancreatic cancer. Although Splenic Vein ligation can cause sinistral portal hypertension, the incidence of clinically relevant sinistral portal hypertension remains unknown, and the roles of the preservation of potential collateral Veins and Splenic Vein reconstruction are controversial. Methods Patients with pancreatic cancer who underwent pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection were assessed for incidence of development of varices by computed tomography at 6 months after pancreatoduodenectomy. We evaluated the risk factors for sinistral portal hypertension and the impact of Splenic Vein reconstruction on sinistral portal hypertension. Results Of the 118 patients who underwent pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection, 31 (26%) underwent Splenic Vein reconstruction, 44 patients (37%) developed gastroesophageal varices, and 5 (11%) experienced varix rupture. Sacrifice of all 3 potential collateral Veins (what we refer to as the critical Veins: left gastric Vein, middle colic Vein, and superior right colic Vein arcade) and absence of any spontaneous splenorenal shunt had a substantial impact on formation of varices. The risk of variceal formation could be stratified based on the number of preserved critical Veins, and patent Splenic Vein reconstruction was associated with a decreased incidence of varices (60% versus 100%, P = .018) among the patients without preservation of the critical Veins. In contrast, patients with multiple intact critical Veins developed no varices, regardless of Splenic Vein reconstruction. Conclusions Sinistral portal hypertension is not uncommon after pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection, and the number of preserved critical Veins helps to predict the risk of sinistral portal hypertension. Thus, the indication for Splenic Vein reconstruction should be tailored according to individual risk factors.
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sinistral portal hypertension after pancreaticoduodenectomy with Splenic Vein ligation
British Journal of Surgery, 2015Co-Authors: Yoshihiro Ono, Kiyoshi Matsueda, Yosuke Inoue, Yu Takahashi, Toshiyuki Unno, Rintaro Koga, Junichi Arita, Michiro Takahashi, Akio SaiuraAbstract:Background Splenic Vein ligation may result in sinistral (left-sided) portal hypertension and gastrointestinal haemorrhage. The aim of this study was to analyse the pathogenesis of sinistral portal hypertension following Splenic Vein ligation in pancreaticoduodenectomy. Methods Patients who underwent pancreaticoduodenectomy for pancreatic cancer between January 2005 and December 2012 were included in this retrospective study. The venous flow pattern from the spleen and Splenic hypertrophy were examined after surgery. Results Of 103 patients who underwent pancreaticoduodenectomy with portal Vein resection, 43 had Splenic Vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose Veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater Splenic hypertrophy than the non-varicose route (median Splenic hypertrophy ratio 1·52 versus 0·94; P < 0·001). All patients with the varicose route had colonic varices, and none had a right colic marginal Vein at the hepatic flexure. Conclusion Pancreaticoduodenectomy with Splenic Vein ligation may lead to sinistral portal hypertension. To avoid the development of varices, it is important to preserve the right colic marginal Vein. Reconstruction of the Splenic Vein should be considered if the right colic marginal Vein is divided.
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Sinistral portal hypertension after pancreaticoduodenectomy with Splenic Vein ligation
The British journal of surgery, 2014Co-Authors: Yoshihiro Ono, Kiyoshi Matsueda, Yosuke Inoue, Yu Takahashi, Toshiyuki Unno, Rintaro Koga, Junichi Arita, Michiro Takahashi, Akio SaiuraAbstract:Background Splenic Vein ligation may result in sinistral (left-sided) portal hypertension and gastrointestinal haemorrhage. The aim of this study was to analyse the pathogenesis of sinistral portal hypertension following Splenic Vein ligation in pancreaticoduodenectomy. Methods Patients who underwent pancreaticoduodenectomy for pancreatic cancer between January 2005 and December 2012 were included in this retrospective study. The venous flow pattern from the spleen and Splenic hypertrophy were examined after surgery. Results Of 103 patients who underwent pancreaticoduodenectomy with portal Vein resection, 43 had Splenic Vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose Veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater Splenic hypertrophy than the non-varicose route (median Splenic hypertrophy ratio 1·52 versus 0·94; P
Yosuke Inoue - One of the best experts on this subject based on the ideXlab platform.
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Impact of portal Vein resection with Splenic Vein reconstruction after pancreatoduodenectomy on sinistral portal hypertension: Who needs reconstruction?
Surgery, 2018Co-Authors: Masayuki Tanaka, Hiromichi Ito, Yoshihiro Ono, Kiyoshi Matsueda, Yoshihiro Mise, Takeaki Ishizawa, Yosuke Inoue, Yu Takahashi, Makiko Hiratsuka, Toshiyuki UnnoAbstract:Background Resection of the porto-mesenterico-Splenic confluence is at times necessary during pancreatoduodenectomy with portal Vein resection for pancreatic cancer. Although Splenic Vein ligation can cause sinistral portal hypertension, the incidence of clinically relevant sinistral portal hypertension remains unknown, and the roles of the preservation of potential collateral Veins and Splenic Vein reconstruction are controversial. Methods Patients with pancreatic cancer who underwent pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection were assessed for incidence of development of varices by computed tomography at 6 months after pancreatoduodenectomy. We evaluated the risk factors for sinistral portal hypertension and the impact of Splenic Vein reconstruction on sinistral portal hypertension. Results Of the 118 patients who underwent pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection, 31 (26%) underwent Splenic Vein reconstruction, 44 patients (37%) developed gastroesophageal varices, and 5 (11%) experienced varix rupture. Sacrifice of all 3 potential collateral Veins (what we refer to as the critical Veins: left gastric Vein, middle colic Vein, and superior right colic Vein arcade) and absence of any spontaneous splenorenal shunt had a substantial impact on formation of varices. The risk of variceal formation could be stratified based on the number of preserved critical Veins, and patent Splenic Vein reconstruction was associated with a decreased incidence of varices (60% versus 100%, P = .018) among the patients without preservation of the critical Veins. In contrast, patients with multiple intact critical Veins developed no varices, regardless of Splenic Vein reconstruction. Conclusions Sinistral portal hypertension is not uncommon after pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection, and the number of preserved critical Veins helps to predict the risk of sinistral portal hypertension. Thus, the indication for Splenic Vein reconstruction should be tailored according to individual risk factors.
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sinistral portal hypertension after pancreaticoduodenectomy with Splenic Vein ligation
British Journal of Surgery, 2015Co-Authors: Yoshihiro Ono, Kiyoshi Matsueda, Yosuke Inoue, Yu Takahashi, Toshiyuki Unno, Rintaro Koga, Junichi Arita, Michiro Takahashi, Akio SaiuraAbstract:Background Splenic Vein ligation may result in sinistral (left-sided) portal hypertension and gastrointestinal haemorrhage. The aim of this study was to analyse the pathogenesis of sinistral portal hypertension following Splenic Vein ligation in pancreaticoduodenectomy. Methods Patients who underwent pancreaticoduodenectomy for pancreatic cancer between January 2005 and December 2012 were included in this retrospective study. The venous flow pattern from the spleen and Splenic hypertrophy were examined after surgery. Results Of 103 patients who underwent pancreaticoduodenectomy with portal Vein resection, 43 had Splenic Vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose Veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater Splenic hypertrophy than the non-varicose route (median Splenic hypertrophy ratio 1·52 versus 0·94; P < 0·001). All patients with the varicose route had colonic varices, and none had a right colic marginal Vein at the hepatic flexure. Conclusion Pancreaticoduodenectomy with Splenic Vein ligation may lead to sinistral portal hypertension. To avoid the development of varices, it is important to preserve the right colic marginal Vein. Reconstruction of the Splenic Vein should be considered if the right colic marginal Vein is divided.
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Sinistral portal hypertension after pancreaticoduodenectomy with Splenic Vein ligation
The British journal of surgery, 2014Co-Authors: Yoshihiro Ono, Kiyoshi Matsueda, Yosuke Inoue, Yu Takahashi, Toshiyuki Unno, Rintaro Koga, Junichi Arita, Michiro Takahashi, Akio SaiuraAbstract:Background Splenic Vein ligation may result in sinistral (left-sided) portal hypertension and gastrointestinal haemorrhage. The aim of this study was to analyse the pathogenesis of sinistral portal hypertension following Splenic Vein ligation in pancreaticoduodenectomy. Methods Patients who underwent pancreaticoduodenectomy for pancreatic cancer between January 2005 and December 2012 were included in this retrospective study. The venous flow pattern from the spleen and Splenic hypertrophy were examined after surgery. Results Of 103 patients who underwent pancreaticoduodenectomy with portal Vein resection, 43 had Splenic Vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose Veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater Splenic hypertrophy than the non-varicose route (median Splenic hypertrophy ratio 1·52 versus 0·94; P
Yu Takahashi - One of the best experts on this subject based on the ideXlab platform.
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Impact of portal Vein resection with Splenic Vein reconstruction after pancreatoduodenectomy on sinistral portal hypertension: Who needs reconstruction?
Surgery, 2018Co-Authors: Masayuki Tanaka, Hiromichi Ito, Yoshihiro Ono, Kiyoshi Matsueda, Yoshihiro Mise, Takeaki Ishizawa, Yosuke Inoue, Yu Takahashi, Makiko Hiratsuka, Toshiyuki UnnoAbstract:Background Resection of the porto-mesenterico-Splenic confluence is at times necessary during pancreatoduodenectomy with portal Vein resection for pancreatic cancer. Although Splenic Vein ligation can cause sinistral portal hypertension, the incidence of clinically relevant sinistral portal hypertension remains unknown, and the roles of the preservation of potential collateral Veins and Splenic Vein reconstruction are controversial. Methods Patients with pancreatic cancer who underwent pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection were assessed for incidence of development of varices by computed tomography at 6 months after pancreatoduodenectomy. We evaluated the risk factors for sinistral portal hypertension and the impact of Splenic Vein reconstruction on sinistral portal hypertension. Results Of the 118 patients who underwent pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection, 31 (26%) underwent Splenic Vein reconstruction, 44 patients (37%) developed gastroesophageal varices, and 5 (11%) experienced varix rupture. Sacrifice of all 3 potential collateral Veins (what we refer to as the critical Veins: left gastric Vein, middle colic Vein, and superior right colic Vein arcade) and absence of any spontaneous splenorenal shunt had a substantial impact on formation of varices. The risk of variceal formation could be stratified based on the number of preserved critical Veins, and patent Splenic Vein reconstruction was associated with a decreased incidence of varices (60% versus 100%, P = .018) among the patients without preservation of the critical Veins. In contrast, patients with multiple intact critical Veins developed no varices, regardless of Splenic Vein reconstruction. Conclusions Sinistral portal hypertension is not uncommon after pancreatoduodenectomy with porto-mesenterico-Splenic confluence resection, and the number of preserved critical Veins helps to predict the risk of sinistral portal hypertension. Thus, the indication for Splenic Vein reconstruction should be tailored according to individual risk factors.
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sinistral portal hypertension after pancreaticoduodenectomy with Splenic Vein ligation
British Journal of Surgery, 2015Co-Authors: Yoshihiro Ono, Kiyoshi Matsueda, Yosuke Inoue, Yu Takahashi, Toshiyuki Unno, Rintaro Koga, Junichi Arita, Michiro Takahashi, Akio SaiuraAbstract:Background Splenic Vein ligation may result in sinistral (left-sided) portal hypertension and gastrointestinal haemorrhage. The aim of this study was to analyse the pathogenesis of sinistral portal hypertension following Splenic Vein ligation in pancreaticoduodenectomy. Methods Patients who underwent pancreaticoduodenectomy for pancreatic cancer between January 2005 and December 2012 were included in this retrospective study. The venous flow pattern from the spleen and Splenic hypertrophy were examined after surgery. Results Of 103 patients who underwent pancreaticoduodenectomy with portal Vein resection, 43 had Splenic Vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose Veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater Splenic hypertrophy than the non-varicose route (median Splenic hypertrophy ratio 1·52 versus 0·94; P < 0·001). All patients with the varicose route had colonic varices, and none had a right colic marginal Vein at the hepatic flexure. Conclusion Pancreaticoduodenectomy with Splenic Vein ligation may lead to sinistral portal hypertension. To avoid the development of varices, it is important to preserve the right colic marginal Vein. Reconstruction of the Splenic Vein should be considered if the right colic marginal Vein is divided.
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Sinistral portal hypertension after pancreaticoduodenectomy with Splenic Vein ligation
The British journal of surgery, 2014Co-Authors: Yoshihiro Ono, Kiyoshi Matsueda, Yosuke Inoue, Yu Takahashi, Toshiyuki Unno, Rintaro Koga, Junichi Arita, Michiro Takahashi, Akio SaiuraAbstract:Background Splenic Vein ligation may result in sinistral (left-sided) portal hypertension and gastrointestinal haemorrhage. The aim of this study was to analyse the pathogenesis of sinistral portal hypertension following Splenic Vein ligation in pancreaticoduodenectomy. Methods Patients who underwent pancreaticoduodenectomy for pancreatic cancer between January 2005 and December 2012 were included in this retrospective study. The venous flow pattern from the spleen and Splenic hypertrophy were examined after surgery. Results Of 103 patients who underwent pancreaticoduodenectomy with portal Vein resection, 43 had Splenic Vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose Veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater Splenic hypertrophy than the non-varicose route (median Splenic hypertrophy ratio 1·52 versus 0·94; P
