How-I-do-it: meso-caval shunt: a safe emergency option for venous reconstruction in pancreaticoduodenectomy

In pancreaticoduodenectomy, extensive involvement of the superior mesenteric vein (SMV) often complicates venous reconstruction, especially when artificial grafts are unavailable. In such cases, meso-caval shunt (MCS) emerges as a solution. This study aimed to evaluate the safety and efficacy of permanent MCS as both an emergency procedure and a planned surgical strategy.

We retrospectively analyzed 8 consecutive patients undergoing pancreaticoduodenectomy with permanent MCS between July 2019 and January 2025 at our institution. Clinicopathological characteristics were identified using electronic medical records, and the same surgeon performed all surgeries.

The study included seven cases of pancreatic cancer and one ampullary carcinoma (6 male, 2 females; age 54-71 years). The mean operative duration was 510 min with 767 ml blood loss. All patients achieved R0 resection with minor complications (Clavien-Dindo grade I/II), no mortality, and preserved portal perfusion. Meso-caval shunt patency was confirmed postoperatively without hepatic dysfunction. Median survival reached 21 months.

Permanent MCS is a reliable elective option for venous reconstruction in pancreaticoduodenectomy, especially when graft-based solutions are not available. Its success in achieving R0 resection while maintaining portal hemodynamics suggests its utility in complex pancreatic resections.