Nicholas Bell-Allen, Shen Wong, Lucian Roseverne, Kai Brown, Anubhav Mittal, Jaswinder Samra
Temporary mesoportal bypass using a ringed PTFE shunt is a technically feasible surgical adjunct during radical pancreatic surgery. In a highly selected, small case series from an expert centre, this protocolised technique facilitated resection in patients considered to have had previously inoperable disease. It does, however, carry a high risk of perioperative morbidity and further evaluation is required to define its safety profile and long-term clinical utility.
BACKGROUND: Surgical resection of locally advanced pancreatic malignancies involving the mesentericoportal axis and adjacent arterial structures present significant technical and oncological challenges. Historically considered inoperable, contemporary neoadjuvant protocols have expanded the cohort eligible for radical resection. This study evaluates the technical feasibility and short-term outcomes of temporary ringed polytetrafluoroethylene (PTFE) mesentericoportal shunt to maintain hepatic perfusion and mesenteric decompression during complex pancreatectomy and vascular reconstruction.
METHODS: A retrospective analysis was conducted on five patients who underwent radical pancreatectomy with synchronous vascular reconstruction at a tertiary Australian centre in 2025. All patients completed neoadjuvant chemotherapy, demonstrating favourable tumor biology. A "bypass-first" technique utilised an 80 × 8 mm ringed PTFE graft to establish a temporary mesentericoportal shunt. Data on preoperative and operative metrics, margin status, and 90-day morbidity and mortality were analysed.
RESULTS: Median operative time was 657 min. Synchronous arterial resection was required in 4 cases. The PTFE shunt successfully maintained mesenteric decompression and continuous hepatic inflow during all vascular reconstructions. R0 resection was achieved in 4 patients. There was no 90-day mortality. Major morbidity (Clavien-Dindo III+) occurred in one patient due to septic shock and bacterial hepatitis, successfully managed with partial hepatectomy. Median ICU and hospital stays were 5 and 15 days.
CONCLUSION: Temporary mesoportal bypass using a ringed PTFE shunt is a technically feasible surgical adjunct during radical pancreatic surgery. In a highly selected, small case series from an expert centre, this protocolised technique facilitated resection in patients considered to have had previously inoperable disease. It does, however, carry a high risk of perioperative morbidity and further evaluation is required to define its safety profile and long-term clinical utility.