Gastric venous congestion after total pancreatectomy: how serious is the problem?

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.