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Portomesenteric Reconstruction During Whipple Procedures: Review and Report of a Case

Southern Arizona Veterans Affairs Health Care System, University of Arizona Health Science Center Tucson, Arizona, luis.leon{at}va.gov

John D. Hughes, MD

Southern Arizona Veterans Affairs Health Care System, University of Arizona Health Science Center Tucson, Arizona

Shemuel B. Psalms, BSHS

Southern Arizona Veterans Affairs Health Care System

Robert Guerra, MD

Southern Arizona Veterans Affairs Health Care System, University of Arizona Health Science Center Tucson, Arizona

Atanu Biswas, MD

Southern Arizona Veterans Affairs Health Care System, University of Arizona Health Science Center Tucson, Arizona

Anil Prasad, MD

Southern Arizona Veterans Affairs Health Care System, University of Arizona Health Science Center Tucson, Arizona

Robert S. Krouse, MD

Southern Arizona Veterans Affairs Health Care System, University of Arizona Health Science Center Tucson, Arizona

A 60-year-old man undergoing a Whipple procedure to treat a pancreatic cancer was found to have tumor adherence to the portal vein. An en block pancreaticoduodenectomy with segmental portal vein resection (PVR) was performed. A primary portal vein anastomosis was initially attempted but failed. Hemodynamic deterioration led the authors to perform a temporary prosthetic portal vein interposition graft and abdominal closure. The following morning, once stable, the patient was brought back to the operating room for autologous reconstruction with femoral vein and completion of the pancreaticoduodenectomy. The role of PVR for vein invasion or tumor adherence during a Whipple procedure is still under debate. However, there is growing evidence that the perioperative morbidity and long-term survival in patients who undergo a pancreaticoduodenectomy with PVR are similar to those of patients without vein resection. Therefore a combined resection of the pancreatic head and the portal vein has been suggested in the absence of other contraindications for resection to be able to offer a curative surgical intervention to a larger number of patients. The authors herein report the details of a patient's case and also review the currently available methods for PVR and reconstruction.

Key Words: Whipple procedure • portal vein resection • portomesenteric reconstruction • pancreatic cancer

Vascular and Endovascular Surgery, Vol. 41, No. 6, 537-546 (2008)
DOI: 10.1177/1538574407305019


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