Preliminary Results of Spleno-aortic bypass in patients with atheromatous celiac trunk stenosis in pancreaticoduodenectomy

Abstract

Background: Pancreaticoduodenectomy (PD) is the only curative treatment of pancreatic head cancer. In case of atheromatous stenosis of the origin of the celiac trunk, interventional radiology is the treatment of choice and yield favorable outcomes allowing thus the realization of PD. But in case of failure of interventional radiology, the only left option is surgery. Herein, we would describe the technique of splenoaortic bypass associated to PD to shunt stenosis of the celiac trunk. Methods: During PD, both hepatic and splenic arteries were dissected. A pancreatectomy was performed from right ot left with preservation of the splenic vein and short vessels. Dissection was performed until the distal part of the pancreas leaving about 4 cm from the hilum. The splenic artery is clamped. To shunt the celiac trunk stenosis, we performed a vascular anastomosis between the splenic artery and the aorta. Doppler ultrasound of the hepatic arterial flow was controlled under clampage of the gastroduodenal artery. Then, this latter was ligated. To avoid the risk of pancreatic fistula, no anastomosis was performed and wirsungostomy was done instead. Bilioenteric and gastrojejunal anastomosis were then confectionned. Results: This technique has been used in three patients. Mortality was nil. No graft loss occurred. Only one patient experienced postoperative spleen abscess that required percutaneous drainage. Multidisciplinary approach allowed best management of pancreatic insuffiency. Conslusions: This technique is safe and feasible. It might be considered as an option in patients candidates to PD with stenosis of the celiac trunk non treatable with endovascular techniques.