Gastric venous congestion after total pancreatectomy: how serious is the problem?
https://doi.org/10.21294/1814-4861-2025-24-5-107-112
Abstract
Introduction. Gastric venous congestion (GVC) after total pancreatectomy (TP) remains a challenging condition which may result in stomach necrosis or bleeding. Here, we present a short series of TPs with two cases of GVC successfully managed by restoring the coronary vein outflow.
Material and Methods. A total of 11 patients were eligible for our study due to stomach-preserving TP. The incidence of GVC and risk factors were estimated. Results. GVC was observed in 2 of 11 patients (18.2 %). The complication was successfully managed by the reconstruction of the gastric coronary vein. The regression model revealed that coronary vein ligation was the only significant predictor of GVC (OR=10.38 [3.97–27.94]). The risk of GVC with the preserved coronary vein was low (OR=0.12 [0.02–0.55]). No gastrectomy was required in both cases.
Conclusion. GVC is a frequent complication of total pancreatectomies which may result in life-threatening conditions, such as stomach necrosis or bleeding. Gastric coronary vein reconstruction is a safe procedure which allows the surgeon to escape unnecessary gastrectomies.
Keywords
total pancreatectomy,
pancreatoduodenectomy,
gastric venous congestion,
gastric venous reconstruction
Supporting agencies: This study required no funding
About the Authors
D. A. Chichevatov
Penza State University
Russian Federation
Russian Federation
Dmitry A. Chichevatov - MD, DSc, Professor, Department of Surgery, Researcher ID (WOS): Q-3647-2017.
40, Krasnaya St., Penza, 440026
V. V. Kalentjev
Penza Regional Oncology Hospital
Russian Federation
Russian Federation
Vyacheslav V. Kalentjev - MD, MSc, Surgeon, Department of Surgery.
37a, Prospect Stroiteley, Penza, 440066
A. E. Glukhov
Penza State University
Russian Federation
Russian Federation
Artem E. Glukhov - MD, MSc, Assistant, Department of Surgery.
40, Krasnaya St., Penza, 440026
References
1. Loos M., Mehrabi A., Ramouz A., Contin P., Strobel O., MüllerStich B.P., Mihaljevic A.L., Diener M.K., Schneider M., Berchtold C., Al-Saeedi M., Goeppert B., Mayer P., Feisst M., Hinz U., Weigand M.A., Hackert T., Büchler M.W. Gastric Venous Congestion After Total Pancreatectomy is Frequent and Dangerous. Ann Surg. 2022; 276(6): 896–904. doi: 10.1097/SLA.0000000000004847.
2. Stoop T.F., von Gohren A., Engstrand J., Sparrelid E., Gilg S., Del Chiaro M., Ghorbani P. Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management. Ann Surg Oncol. 2023; 30(12): 7700–11. doi: 10.1245/s10434-023-13847-z.
3. Yamanaka T., Araki K., Suzuki H., Osawa H., Shirabe K. Intraoperative severe gastric venous congestion during total pancreatectomy with replaced common hepatic artery: a case report. Surg Case Rep. 2024; 10(1): 184. doi: 10.1186/s40792-024-01983-x.
4. Nakao A., Yamada S., Fujii T., Tanaka H., Oshima K., Oshima Y., Iede K., Kobayashi H., Kimura Y., Kodera Y. Gastric venous congestion and bleeding in association with total pancreatectomy. J Hepatobiliary Pancreat Sci. 2018; 25(2): 150–54. doi: 10.1002/jhbp.523.
5. Reddy R.C., Chaudhari V., Chopde A., Mitra A., Jaiswal D., Shrikhande S.V., Bhandare M.S. Gastric salvage after venous congestion during major pancreatic resections: A series of three cases. Ann Hepatobiliary Pancreat Surg. 2024; 28(1): 99–103. doi: 10.14701/ahbps.23-089.
6. Lee H., Lee J. Anatomic variations in the left gastric vein and their clinical significance during laparoscopic gastrectomy. Surg Endosc. 2019; 33(6): 1903–909. doi: 10.1007/s00464-018-6470-z.
7. Bedin V.V., Tavobilov M.M., Karpov A.A., Mikhaylants G.S., Lantsynova A.V., Abramov K.A. The role of the left gastric vein in the preservation of the stomach during total duodenopancreatectomy in the modification of Botkin Hospital. Moscow Surgical Journal. 2023; (1): 18–26. (in Russian). doi: 10.17238/2072-3180-20231-18-26. EDN: LYZWFM.
8. Hackert T., Weitz J., Büchler M.W. Reinsertion of the gastric coronary vein to avoid venous gastric congestion in pancreatic surgery. HPB (Oxford). 2015; 17(4): 368–70. doi: 10.1111/hpb.12321.
9. Mehrabi A., Loos M., Ramouz A., Dooghaie Moghadam A., Probst P., Nickel F., Schaible A., Mieth M., Hackert T., Büchler M.W. Gastric venous reconstruction to reduce gastric venous congestion after total pancreatectomy: study protocol of a single-centre prospective non-randomised observational study (IDEAL Phase 2A) – GENDER study (Gastric vENous DrainagE Reconstruction). BMJ Open. 2021; 11(10): e052745. doi: 10.1136/bmjopen-2021-052745.
Review
For citations:
Chichevatov D.A., Kalentjev V.V., Glukhov A.E. Gastric venous congestion after total pancreatectomy: how serious is the problem? Siberian journal of oncology. 2025;24(5):107-112. https://doi.org/10.21294/1814-4861-2025-24-5-107-112
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