Superior Mesenteric Vein Injury During Oncologic Right Colectomy: Current Vascular Repair Modalities
Abstract
Purpose:
To review the different vascular repair options of superior mesenteric vein (SMV) damage during oncologic right colectomy.
Methods:
This is a retrospective chart review of 5 cases in which severe damage to the SMV occurred during oncological right colectomy in an academic medical center.
Results:
During a 10-year study period, we encountered 5 cases in which severe damage to the SMV and its tributaries occurred. Two of the patients underwent primary venous repair for partial lacerations. The other 3 underwent interposition graft repair using a great saphenous vein (GSV) graft. Two of the grafts remained patent, while the third required replacement with a bovine pericardial patch.
Conclusions:
The SMV injury during oncologic right colectomy is a technically challenging injury. Based on our own experience and review of the literature, we formulated the following set of recommendations: (1) Venous ligation should be avoided, and revascularization should be attempted whenever feasible. (2) Primary venorrhaphy in cases of partial lacerations is the preferred treatment option. (3) End-to-end anastomosis is an efficient but seldom available repair option in the setting of complete SMV transection without segmental loss. (4) Autologous vein graft using the GSV is the preferred mode of repair during SMV injury with tissue loss. (5) Use of polytetrafluoroethylene (PTFE) graft should be avoided if possible due to greater risk of graft contamination. (6) A low threshold for reexploration depending on laboratory and imaging findings is advisable.
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References
1. Freund MR, Edden Y, Reissman P, et al. Iatrogenic superior mesenteric injury: the perils of high ligation. Int J Colorectal Dis. 2016;31(9):1649–1651.
2. Park IJ, Chang GJ. Surgical management of cancer of the colon. In: Fazio VW, Church JM, Delaney CP, Kiran RP, eds. Current Therapy in Colon and Rectal Surgery. 3rd ed. Chapter 61. Elsevier, 2017.
3. Graham JM, Mattox KL, Beall AC Jr. Portal venous system injuries. J Trauma. 1978;18(6):419–422.
4. Fraga GP, Bansal V, Fortlage D, et al. A 20-year experience with portal and superior mesenteric venous injuries: has anything changed? Eur J Vasc Endovasc Surg. 2009;37(1):87–91.
5. Donahue TK, Strauch GO. Ligation as definitive management of injury to the superior mesenteric vein. J Trauma. 1988;28(4):541–543.
6. Asensio JA, Petrone P, Garcia-Nuñez L, et al. Superior mesenteric venous injuries: to ligate or to repair remains the question. J Trauma. 2007;62(3):668–675.
7. Asensio JA, Forno W, Roldán G, et al. Visceral vascular injuries. Surg Clin North Am. 2002;82(1):1–20.
8. Stone HH, Fabian TC, Turkleson ML. Wounds of the portal venous system. World J Surg. 1982;6(3):335–341.
9. Oderich GS, Panneton JM, Hofer J, et al. Iatrogenic operative injuries of abdominal and pelvic veins: a potentially lethal complication. J Vasc Surg. 2004;39(5):931–936.
10. Cusack JC Jr, Fuhrman GM, Lee JE, et al. Managing unsuspected tumor invasion of the superior mesenteric-portal venous confluence during pancreaticoduodenectomy. Am J Surg. 1994;168(4):352–354.
11. Feliciano DV, Mattox KL, Graham JM, et al. Five-year experience with PTFE grafts in vascular wounds. J Trauma. 1985;25(1):71–82.
12. Vaughn GD, Mattox KL, Feliciano DV, et al; Surgical experience with expanded polytetrafluorethylene (PTFE) as a replacement graft for traumatized vessels. J Trauma. 1979;19(6):403.
13. Reissman P, Anner H, Berlatzky Y. A simple technique for the use of a variable length compilation vein graft in major venous injury. J Am Coll Surg. 1995;181(2):175–177.
14. Kleive D, Berstad AE, Verbeke CS, et al. Cold-stored cadaveric venous allograft for superior mesenteric/portal vein reconstruction during pancreatic surgery. HPB. 2016;18(7):615–622.
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Article first published online: November 9, 2017
Issue published: January 2018
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PubMed: 29121842
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This article was published in Vascular and Endovascular Surgery.
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