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Revisiting vascular patency after spleen-preserving laparoscopic distal pancreatectomy with conservation of splenic vessels.

Hwang HK, Chung YE, Kim KA, Kang CM, Lee WJ - Surg Endosc (2012)

Bottom Line: A total of five patients (17.2%) showed grade 1 or 2 obliteration in conserved splenic veins.Most patients (82.8%) had patent conserved splenic vein.Four patients (13.8%) eventually developed collateral venous vessels around gastric fundus and reserved spleen, but no spleen infarction was found, and none presented clinical relevant symptoms, such as variceal bleeding.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. DRHHK@yuhs.ac

ABSTRACT

Background: We evaluated vascular patency and potential changes in preserved spleens after laparoscopic spleen-preserving distal pancreatectomy (SPDP) with conservation of both splenic vessels.

Methods: We retrospectively analyzed the patency of conserved splenic vessels in patients who underwent laparoscopic or robotic splenic vessel-conserving SPDP from January 2006 to August 2010. The patency of the conserved splenic vessels was evaluated by abdominal computed tomography and classified into three grades according to the degree of severity.

Results: Among 30 patients with splenic vessel-conserving laparoscopic SPDP, 29 patients with complete follow-up data were included in this study. During the follow-up period (median: 13.2 months), grades 1 and 2 splenic arterial obliteration were observed in one patient each. A total of five patients (17.2%) showed grade 1 or 2 obliteration in conserved splenic veins. Most patients (82.8%) had patent conserved splenic vein. Four patients (13.8%) eventually developed collateral venous vessels around gastric fundus and reserved spleen, but no spleen infarction was found, and none presented clinical relevant symptoms, such as variceal bleeding. There was no statistical difference in vascular patency between the laparoscopic and robotic groups (P > 0.05).

Conclusions: Most patients showed intact vascular patency in conserved splenic vessels and no secondary changes in the preserved spleen after laparoscopic splenic vessel-conserving SPDP.

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Grading system of vascular patency and collateral vessels. A Splenic artery patency (G0, G1, G2). A-0 Grade 0 patency: splenic artery (arrow) is well conserved (grade 0). A-1 Splenic artery (arrow) is partially stenotic status (grade 1). A-2 Splenic artery (arrow) is near totally obstructed (grade 2), otherwise, splenic vein (arrowhead) is intact. B Splenic vein patency (G0, G1, G2). B-0 Splenic vein (arrow) was well preserved (grade 0). B-1 Splenic vein has partially stenotic status (grade 1). The arrowhead indicates the resection margin of the pancreas. B-2 Splenic vein (arrow) is totally obstructed. C Degree of collateral vessels (G0, G1, G2). C-0 There were no collateral vessels (grade 0). C-1 Gastric fundal varix is newly developed after surgery (grade 1). C-2 More prominent gastric fundal and perigastric venous engorgement was observed (grade 2). P remnant pancreas; O fluid collection on resected site
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Fig1: Grading system of vascular patency and collateral vessels. A Splenic artery patency (G0, G1, G2). A-0 Grade 0 patency: splenic artery (arrow) is well conserved (grade 0). A-1 Splenic artery (arrow) is partially stenotic status (grade 1). A-2 Splenic artery (arrow) is near totally obstructed (grade 2), otherwise, splenic vein (arrowhead) is intact. B Splenic vein patency (G0, G1, G2). B-0 Splenic vein (arrow) was well preserved (grade 0). B-1 Splenic vein has partially stenotic status (grade 1). The arrowhead indicates the resection margin of the pancreas. B-2 Splenic vein (arrow) is totally obstructed. C Degree of collateral vessels (G0, G1, G2). C-0 There were no collateral vessels (grade 0). C-1 Gastric fundal varix is newly developed after surgery (grade 1). C-2 More prominent gastric fundal and perigastric venous engorgement was observed (grade 2). P remnant pancreas; O fluid collection on resected site

Mentions: We used the classification system of splenic vessel patency that was defined by Yoon et al. [7]. The patency of the splenic artery and vein were classified into three grades according to the degree of stenosis: intact (grade 0), partial occlusion or thrombosis (grade 1), and total occlusion or unidentified (grade 2; Fig. 1A, B). The degree of the collateral vessels was classified into three grades: no collateral vessels (grade 0), partial collateral vessels (grade 1), and prominent collateral vessels (grade 2; Fig. 1C). Two radiologists came to a consensus in assessing the degree of splenic vessel stenosis with a retrospective review of the CT scan.Fig. 1


Revisiting vascular patency after spleen-preserving laparoscopic distal pancreatectomy with conservation of splenic vessels.

Hwang HK, Chung YE, Kim KA, Kang CM, Lee WJ - Surg Endosc (2012)

Grading system of vascular patency and collateral vessels. A Splenic artery patency (G0, G1, G2). A-0 Grade 0 patency: splenic artery (arrow) is well conserved (grade 0). A-1 Splenic artery (arrow) is partially stenotic status (grade 1). A-2 Splenic artery (arrow) is near totally obstructed (grade 2), otherwise, splenic vein (arrowhead) is intact. B Splenic vein patency (G0, G1, G2). B-0 Splenic vein (arrow) was well preserved (grade 0). B-1 Splenic vein has partially stenotic status (grade 1). The arrowhead indicates the resection margin of the pancreas. B-2 Splenic vein (arrow) is totally obstructed. C Degree of collateral vessels (G0, G1, G2). C-0 There were no collateral vessels (grade 0). C-1 Gastric fundal varix is newly developed after surgery (grade 1). C-2 More prominent gastric fundal and perigastric venous engorgement was observed (grade 2). P remnant pancreas; O fluid collection on resected site
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Fig1: Grading system of vascular patency and collateral vessels. A Splenic artery patency (G0, G1, G2). A-0 Grade 0 patency: splenic artery (arrow) is well conserved (grade 0). A-1 Splenic artery (arrow) is partially stenotic status (grade 1). A-2 Splenic artery (arrow) is near totally obstructed (grade 2), otherwise, splenic vein (arrowhead) is intact. B Splenic vein patency (G0, G1, G2). B-0 Splenic vein (arrow) was well preserved (grade 0). B-1 Splenic vein has partially stenotic status (grade 1). The arrowhead indicates the resection margin of the pancreas. B-2 Splenic vein (arrow) is totally obstructed. C Degree of collateral vessels (G0, G1, G2). C-0 There were no collateral vessels (grade 0). C-1 Gastric fundal varix is newly developed after surgery (grade 1). C-2 More prominent gastric fundal and perigastric venous engorgement was observed (grade 2). P remnant pancreas; O fluid collection on resected site
Mentions: We used the classification system of splenic vessel patency that was defined by Yoon et al. [7]. The patency of the splenic artery and vein were classified into three grades according to the degree of stenosis: intact (grade 0), partial occlusion or thrombosis (grade 1), and total occlusion or unidentified (grade 2; Fig. 1A, B). The degree of the collateral vessels was classified into three grades: no collateral vessels (grade 0), partial collateral vessels (grade 1), and prominent collateral vessels (grade 2; Fig. 1C). Two radiologists came to a consensus in assessing the degree of splenic vessel stenosis with a retrospective review of the CT scan.Fig. 1

Bottom Line: A total of five patients (17.2%) showed grade 1 or 2 obliteration in conserved splenic veins.Most patients (82.8%) had patent conserved splenic vein.Four patients (13.8%) eventually developed collateral venous vessels around gastric fundus and reserved spleen, but no spleen infarction was found, and none presented clinical relevant symptoms, such as variceal bleeding.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. DRHHK@yuhs.ac

ABSTRACT

Background: We evaluated vascular patency and potential changes in preserved spleens after laparoscopic spleen-preserving distal pancreatectomy (SPDP) with conservation of both splenic vessels.

Methods: We retrospectively analyzed the patency of conserved splenic vessels in patients who underwent laparoscopic or robotic splenic vessel-conserving SPDP from January 2006 to August 2010. The patency of the conserved splenic vessels was evaluated by abdominal computed tomography and classified into three grades according to the degree of severity.

Results: Among 30 patients with splenic vessel-conserving laparoscopic SPDP, 29 patients with complete follow-up data were included in this study. During the follow-up period (median: 13.2 months), grades 1 and 2 splenic arterial obliteration were observed in one patient each. A total of five patients (17.2%) showed grade 1 or 2 obliteration in conserved splenic veins. Most patients (82.8%) had patent conserved splenic vein. Four patients (13.8%) eventually developed collateral venous vessels around gastric fundus and reserved spleen, but no spleen infarction was found, and none presented clinical relevant symptoms, such as variceal bleeding. There was no statistical difference in vascular patency between the laparoscopic and robotic groups (P > 0.05).

Conclusions: Most patients showed intact vascular patency in conserved splenic vessels and no secondary changes in the preserved spleen after laparoscopic splenic vessel-conserving SPDP.

Show MeSH
Related in: MedlinePlus