How-I-do-it: a novel technique of portal vein-right gastroepiploic vein side-to-side anastomosis to improve gastric venous congestion following total pancreatectomy: a retrospective cohort study and literature review (with video).

Purpose: The aim of the present study was to evaluate the outcomes and preventive techniques for gastric venous congestion (GVC) following total pancreatectomy (TP), with a focus on gastric venous drainage reconstruction.

Methods: This retrospective single-center study included patients who underwent TP between January 2019 and June 2024, encompassing both primary one-step TP and planned elective completion pancreatectomy following either pancreatoduodenectomy (PD) or distal pancreatectomy (DP). Intraoperative evaluation and reconstruction of gastric venous drainage were performed when GVC was observed. Demographic, clinical, technical, perioperative, and postoperative data were analyzed.

Results: Sixteen patients underwent either one-step TP (n = 4) or elective completion pancreatectomy (n = 12), including four following DP and eight following PD. Intraoperative GVC was detected in two patients, necessitating portal vein (PV)-right gastroepiploic vein (RGEV) side-to-side anastomosis. No major complications occurred in these patients, and no GVC was observed during the postoperative follow-up period (mean: 39.8 months, range: 2.1-60.7 months).

Conclusion: In cases where preservation of gastric drainage veins is not feasible, PV-RGEV side-to-side anastomosis can be a convenient and useful option to resolve intraoperative GVC.