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2006 Abstracts: Durability of Portal Venous Reconstruction Following Resection During Pancreaticoduodenectomy Rory L. Smoot MD, John D. Christein MD, Michael B. Farnell MD Division of GI and General Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Durability of Portal Venous Reconstruction Following Resection During Pancreaticoduodenectomy Rory L. Smoot MD, John D. Christein MD, Michael B. Farnell MD Division of GI and General Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
Rory Smoot1, John Christein2, Michael Farnell1; 1Surgery, Mayo Clinic, Rochester, MN; 2Surgery, Univerisity of Alabama Birmingham, Birmingham, AL

Background: Venous resection and reconstruction is becoming more common during pancreaticoduodenectomy (PD). There are multiple options for reconstruction of the mesenteric venous system ranging from primary repair to grafting with autologous or synthetic material. Few studies report on the patency rates and long-term morbidity of these repairs. We sought to describe our experience with venous reconstruction during PD with specific attention to patency and long-term morbidity and mortality. Hypothesis: Thrombosis rates of mesenteric venous reconstruction during PD are low, with low associated morbidity. Design: Retrospective Cohort Patient and Methods: Clinical, operative, and pathologic data were collected from consecutive patients 1988-2003. Graft patency on follow-up imaging studies was determined and short as well as long-term morbidity and mortality were recorded. Results: Sixty-four patients underwent PD with venous resection/reconstruction from 1988-2003. Mean age was 63 years with pancreatic ductal adenocarcinoma as the pathology in 88%. Reconstruction consisted of primary lateral venorrhapy in 29 (45%), PTFE graft in 18 (28%), primary end-to-end repair in 13 (20%), and autologous vein graft in 4 (6%). There was one peri-operative death (2%). Follow-up imaging to assess patency was available for a mean of 12.2 months postoperatively. Eleven thromboses were diagnosed at a mean of 11.9 months. Three thromboses (5%) were noted within 30 days requiring full anticoagulation. Fifty-three percent of patients received anticoagulation with aspirin, warfarin, or clopidogrel. There was no difference in thrombosis rates in those receiving anticoagulation and those that did not (p=1.0). In those patients with thrombosis outside the acute time period morbidity was limited to ascites in three patients and splenic vein thrombosis with uncomplicated esophageal varices in another patient. Conclusions: Mesenteric venous resection and reconstruction during PD has a high patency rate, and those reconstructions that do thrombose are associated with a low morbidity. The majority of reconstruction thromboses are associated with recurrence.


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