Parietal Peritoneum for Venous Reconstruction in 145 Patients: Long Term Patency and Risk Factors of Thrombosis

Abstract

Introduction: We described in 2015 venous reconstruction in HPB surgery with the parietal peritoneum (PP) in 30 patients with excellent results. Herien we report the long term patency and risk factors for thrombosis in 145 patients. Method: Between 2010-2019, 145 patients underwent pancreatic (n=103) or liver (n=42) surgery with reconstruction of the mesentericoportal vein (104), the vena cava (18), hepatic veins (9), and portal confluence (14). The PP (mean length=26 mm; 10-100) was harvested from the falciform ligament (n=67;46%), hypochondrium (n=27; 19%), diaphragm (n=24; 16%), or prerenal (n=27; 19%) area, for lateral (140) or tubular (5) reconstruction. Postoperative anticoagulation was standard. Early (<30 days) and delayed (>30 days) were analysed. The mean radiological follow-up was 20 (1-84) months. Results: Two non related mortalities with no PP-related or haemorraghic complications. The early and delayed patency rate for the all population, pancreatic and liver surgery were (92% and 80%), (88% and 75%), and (98% and 90%), respectively. Early thrombosis (n=12) was observed mainly after pancreatic surgery (11/12; 92% ) and was symptomatic in one patient with reintervention. Delayed thrombosis (n=18) was associated with local/distant recurrence of the disease in 11 patients (11/18; 61%). The main risk factors for complete thrombosis were preoperative chemotherapy and radiotherapy (p= 0.022; OR = 2.815[1.164 ; 6.806] and distal pancreatectomy (p= 0.008; OR = 3.730[1.411 ; 9.859]. Conclusions: The long term results of venous reconstruction with the PP are good, with very low risk of symptomatic thrombosis, and are better after liver than pancreatic surgery.