Can the Falciform Ligament Be the Most Ergonomic Patch in Portal Vein Reconstruction?

The target in pancreatic cancer surgery is to achieve R0 resection margin. Portal vein resection and reconstruction may be required for a clear margin. This case series is an evaluation of pancreatic cancer patients who underwent portal vein resection during pancreatico-duodenectomy. From January 2012 to January 2020 pancreatico-duodenectomy was performed in 134 patients and all consecutively done surgeries have been included. Of these 9 subjects required portal vein resection (male = 6, female = 3). The mean age was 65 years. Primary suturing and repair of portal vein could be successfully done in 4/9, portal vein primary anastomosis achieved in 2/9, and in 3 of 9 patients the portal vein defect being larger was repaired and successfully closed using a patch prepared from the falciform ligament. The patch was sutured to the portal vein with a continuous 5/0 prolene stitch. None of the 3 patients with falciform patch had complications such as bleeding or stenosis after 5 months following surgery. This technique has been used so far in the repair of perforation of the stomach and duodenum, in the control of pancreatic fistula and most importantly in the repair of defects in the vena cava. This study suggests that locally and immediately available falciform ligament can be used as an autologous graft to patch portal vein defects and is a valuable technique.