Zhao D, Huang YM, Liang ZM, Zhang KJ, Fang TS, Yan X, Jin X, Zhang Y, Tang JX, Xie LJ, Zeng XC. Reconstructing the portal vein through a posterior pancreatic tunnel: New choice for portal vein thrombosis during liver transplantation. World J Gastrointest Surg 2022; 14(10): 1131-1140 [PMID: 36386397 DOI: 10.4240/wjgs.v14.i10.1131]
Corresponding Author of This Article
Dong Zhao, MD, Professor, Surgeon, Department of Liver Surgery and Organ Transplantation Center, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, No. 29 Bulan Road, Longgang District, Shenzhen 518000, Guangdong Province, China. zdong1233@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Dong Zhao, Yi-Ming Huang, Zi-Ming Liang, Kang-Jun Zhang, Tai-Shi Fang, Xu Yan, Xin Jin, Yi Zhang, Jian-Xin Tang, Lin-Jie Xie, Xin-Chen Zeng, Department of Liver Surgery and Organ Transplantation Center, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen 518000, Guangdong Province, China
Author contributions: Zhao D and Huang YM were involved in the conception and design of this study; Zhao D provided administrative support in this study; Tang JX, Zhang KJ, Fang TS, and Zeng XC contributed to the provision of study materials or patients; Liang ZM, Yan X, Jin X, and Xie LJ were involved in the collection and assembly of data; Zhang Y and Huang YM analysed and interpreted the data; and all authors approved this manuscript to publish.
Supported bythe Third People’s Hospital of Shenzhen Scientific Research Project, No. G2021008 and No. G2022008; Shenzhen Key Medical Discipline Construction Fund, No. SZXK079; Shenzhen Science and Technology Research and Development Fund, No. JCYJ20190809165813331 and No. JCYJ20210324131809027.
Institutional review board statement: The study was reviewed and approved by the Third People’s Hospital of Shenzhen Institutional Review Board (Approval No. 2022-037-02).
Informed consent statement: All cases involved in this study proved written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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: Dong Zhao, MD, Professor, Surgeon, Department of Liver Surgery and Organ Transplantation Center, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, No. 29 Bulan Road, Longgang District, Shenzhen 518000, Guangdong Province, China. zdong1233@126.com
Received: July 14, 2022 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 Processing time: 102 Days and 21.9 Hours
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
We sought to describe a new strategy of RPVPPT to address cases of unresectable PVT.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
Due to the relatively small number of cases in the study, follow-up studies with large samples are still required.
