Autologous Peritoneum Graft Repair of a Superior Mesenteric Vein Defect During Pancreaticoduodenectomy

Autologous peritoneal graft for venous vascular reconstruction after tumor resection in abdominal surgery: a systematic review

Radical surgical resection (R0) is the only option to cure patients with borderline resectable or multivisceral intraabdominal malignancies involving major vessels. Autologous peritoneal flap has been described as a safe and versatile option for vascular reconstruction, but still limited experience exists regarding its use. An extensive literature review was performed to analyze results of vascular reconstruction with an autologous peritoneal graft. Fifteen reports were found for a total of 94 patients. No cases of arterial vascular reconstruction were found. Two different types of peritoneal patch have been described, backed (APFG, 30 patients) or not backed (ANFP, 64 patients) by posterior rectus sheath. A patch type of reconstruction was adopted in 70 patients (74.5%), while a tubular reconstruction in 24 (25.5%). Postoperative mortality was 5.3% (5 cases). Graft outcomes with very heterogeneous follow-ups (7 days-47 months) were available only in 85 patients (90.4%). Among them, a graft patency was documented in 80 patients (94.1%), while a stenotic graft was reported in 5 patients (5.9%). No differences in graft outcomes were observed between the patch and tubular groups (p = 0.103), nor between the ANFP and APFG groups (p = 0.625). In reported experiences, autologous peritoneal graft seems to represent a safe and versatile option for functional restoration of venous vascular anatomy after resection, especially in operations with high risk of contamination, trauma, liver transplantation and unplanned vascular resection. Unfortunately, the data available in the literature do not make it possible to draw any evidence-based conclusions on these considerations.

PARIETAL PERITONEUM GRAFT FOR DUODENUM INJURIES IN AN ANIMAL MODEL

Background:

Duodenal injuries and their surgical procedure cause a high morbidity and mortality.

Aim:

To assess the overall effectiveness of the auto-graft of peritoneum in the treatment of the perforation of the duodenum, aiming to reduce surgery time, costs, complexity and mortality.

Methods:

Twelve New Zealand rabbits, ages 4-6 months, both sexes, underwent designed surgical grade III duodenal injuries that were repaired 18 h after. Rabbits were surgically treated with the proposed auto-graft of peritoneum.

Results:

No postoperative deaths were observed; the animals presented corporal weight increase and were euthanized six months later. There was no significant difference between both groups relating to the postoperative evolution or in the histological changes.

Conclusion:

Auto-graft of the peritoneum and posterior fascia is a useful option for duodenal repair and that is worth of evaluation for humans.