A SPLENIC-INFERIOR MESENTERIC VENOUS ANASTOMOSIS PREVENTS GASTRIC CONGESTION FOLLOWING PYLORUS-PRESERVING PANCREATICODUODENECTOMY WITH EXTENSIVE PORTAL-VEIN RESECTION FOR CANCER OF THE HEAD OF THE PANCREAS

Background, In order to prevent gastric congestion after both of the s plenic and coronary veins were taken as part of extensive portal vein resection in pylorus preserving (PP) pancreatoduodenectomy (PD), we ma de a splenic-inferior mesenteric venous (SpIMV) anastomosis. Materials ann methods, Four patients underwent PP subtotal PD with such extensi ve portal vein resection under the diagnosis of pancreas head cancer, The portal vein was reconstructed by end-to-end anastomosis, and the c oronary vein was ligated, Since the stump of the splenic vein could no t be approximated to the portal or superior mesenteric vein, shunting the splenic venous flow to the inferior mesenteric vein was attempted by making a SpIMV anastomosis in 3 patients and by preserving the SpIM V confluence in a patient, Postoperative celiac angiography showed tha t venous outflow from the stomach, spleen and remnant pancreas collect ed into the splenic vein and passed through the SpIMV anastomosis or c onfluence, and finally drained into the portal vein by inferior mesent eric to superior mesenteric collateral, Results. No remarkable congest ion of the stomach was observed, Conclusions. In conclusion making a S pIMV anastomosis or preserving the SpIMV confluence is beneficial for preventing gastric congestion following PP PD with extensive portal ve in resection for cancer of the head of the pancreas.