Pancreatic Surgery in Chronic Pancreatitis Complicated by Extrahepatic Portal Hypertension or Cavernous Transformation of the Portal Vein: A Systematic Review

Objectives: Chronic pancreatitis produces disabling pain and loss of pancreatic endocrine/exocrine function. Almost half of the patients will need surgery during the course of the disease. Certain conditions, such as extrahepatic portal hypertension or cavernous transformation of the portal vein, can increase the risk of morbidity and mortality. These complications must be borne in mind in the design of the surgical treatment of chronic pancreatitis. This study is a systematic review on the coexistence of chronic pancreatitis and extrahepatic portal hypertension/cavernous transformation in patients undergoing pancreatic surgery. Methods: We conducted an unlimited search updated on 10 December 2017, which yielded 535 results. We selected 11 articles. Results: Main indication for surgery was intractable pain. Presence of extrahepatic portal hypertension and/or cavernous transformation increased intraoperative bleeding and general postoperative morbidity, though the increase in general morbidity was less when the different postoperative complications were analyzed individually. Case series showed a higher mortality in patients with extrahepatic portal hypertension. Conclusion: Little is known about the presence of extrahepatic portal hypertension in patients undergoing pancreatic surgery for chronic pancreatitis. More studies are needed in order to standardize criteria for vascular involvement in patients with chronic pancreatitis, in order to select the surgical technique and, if necessary, to establish contraindications, in this subgroup of patients.

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Pancreatic surgery in patients with chronic pancreatitis and extrahepatic portal hypertension: a systematic review

HPB ◽

10.1016/j.hpb.2018.06.1886 ◽

2018 ◽

Vol 20 ◽

pp. S511

Author(s):

A. Manuel ◽

R. Latorre Fragua ◽

A. Lopez Marcano ◽

A. Medina Velasco ◽

C. Garcia Amador ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pancreatitis ◽

Portal Hypertension ◽

Pancreatic Surgery ◽

Extrahepatic Portal Hypertension

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HEMODYNAMIC FEATURES IN CHILDREN WITH EXTRAHEPATIC PORTAL HYPERTENSION IN CAVERNOUS TRANSFORMATION OF PORTAL VEIN PRE- AND POSTOPERATIVELY OF PORTO-SYSTEMIC SHUNTING

Siberian medical review ◽

10.20333/25000136-2014-5-63-67 ◽

2014 ◽

pp. 63-67

Author(s):

N. A. Ranchaeva ◽

◽

V. A. Yurchuk ◽

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Extrahepatic Portal Hypertension ◽

Cavernous Transformation

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Cavernous transformation of portal vein a missed cause of extrahepatic portal hypertension

BMJ Case Reports ◽

10.1136/bcr.12.2011.5331 ◽

2012 ◽

Vol 2012 (feb25 1) ◽

pp. bcr1220115331-bcr1220115331

Author(s):

A. K. Vaish ◽

N. Kumar ◽

N. Jain ◽

A. Agarwal

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Extrahepatic Portal Hypertension ◽

Cavernous Transformation

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Portal vein arterialization as a salvage procedure in hepatopancreatobiliary surgery: a systematic review

Canadian Journal of Surgery ◽

10.1503/cjs.012419 ◽

2021 ◽

Vol 64 (2) ◽

Author(s):

Ali Majlesara ◽

Omid Ghamarnejad ◽

Elias Khajeh ◽

Mohammad Golriz ◽

Negin Gharabaghi ◽

...

Keyword(s):

Systematic Review ◽

Portal Hypertension ◽

Portal Vein ◽

Animal Studies ◽

Survival Rates ◽

Celiac Trunk ◽

Salvage Procedure ◽

Portal Vein Arterialization ◽

Hepatopancreatobiliary Surgery ◽

Meta Analyses

Background: Portal vein arterialization (PVA) is a possible option when hepatic artery reconstruction is impossible during liver resection. The aim of this study was to review the literature on the clinical application of PVA in hepatopancreatobiliary (HPB) surgery. Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched the PubMed, Embase and Web of Science databases until December 2019. Experimental (animal) studies, review articles and letters were excluded. Results: Twenty studies involving 57 patients were included. Cholangiocarcinoma was the most common indication for surgery (40 patients [74%]). An end-to-side anastomosis between a celiac trunk branch and the portal vein was the main PVA technique (35 patients [59%]). Portal hypertension was the most common longterm complication (12 patients [21%] after a mean of 4.1 mo). The median followup period was 12 (range 1–87) months. The 1-, 3- and 5-year survival rates were 64%, 27% and 20%, respectively. Conclusion: Portal vein arterialization can be considered as a rescue option to improve the outcome in patients with acute liver de-arterialization when arterial reconstruction is not possible. To prevent portal hypertension and liver injuries due to thrombosis or overarterialization, vessel calibre adjustment and timely closure of the anastomosis should be considered. Further prospective experimental and clinical studies are needed to investigate the potential of this procedure in patients whose liver is suddenly de-arterialized during HPB procedures.

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A73 PHARYNGEAL VARICES AS A COMPLICATION OF PORTAL HYPERTENSION: A CASE SERIES

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.072 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 86-88

Author(s):

J Ghaith ◽

P James ◽

F Wong

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Esophageal Varices ◽

Splenic Vein ◽

Case Series ◽

Brachiocephalic Vein ◽

Splenic Vein Thrombosis ◽

Vein Thrombosis ◽

Ectopic Varices ◽

Collateral Vessels

Abstract Background One of the complications of portal hypertension, with or without the presence of cirrhosis, is the development of varices along the length of the gastrointestinal tract. The commonest sites are along the esophagus or in the stomach. Ectopic varices in the small and large bowels can also be observed, but ectopic varices in the pharynx are extremely uncommon. Aims To present a case series and review the literature regarding pharyngeal varcies. Methods - Results Three elderly female patients presented for esophagogastric varices surveillance gastroscopy were diagnosed with pharyngeal varices. One patient has hepatitis C cirrhosis, while the other two non-cirrhotic patients have myeloproliferative neoplasm (MPN). None of the patients had thromboses of the portal vein or its tributaries. All three patient have concomitant esophageal varices, but only one required band ligation of her esophageal varices. All patients are asymptotic except for mild dysphagia. No patient has bled from their pharyngeal varices to date. Two patients have had prophylactic treatment of their portal hypertension with non-selective beta blocker (NSBB), while the third one has not received NSBB prophylaxis because of her age. Conclusions Pharyngeal varices are extremely rare. To date, there are three case reports in the literature, however, we have been able to identify three cases in our practice. The previous two cases reported possible left-sided portal hypertension with splenic vein thrombosis, leading to the development of collateral vessels including a gastrocaval shunt, which by some contiguous route connects to the brachiocephalic vein; and a third case was a complication of neck dissection surgery. In our case series, none of our patients had splenic vein thrombosis. However, none of them has had a careful CT angiogram to delineate the portal vein tributaries and the collateral vessels, which may further help to define their pathogenesis. It is unclear whether NSBB would be effective as primary prophylaxis against their bleeding, The plan is to continue to monitor these patients to learn about the natural history of these pharyngeal varices. Funding Agencies None

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