Emergency Portal Vein Reconstruction with Polytetrafluoroethylene Grafts after Laparoscopic Cholecystectomy Injuries: Identifying the Survival Window and Critical Prognostic Factors

Background: Laparoscopic cholecystectomy is the standard procedure for symptomatic gallstones. Significant vascular injuries, particularly to the portal vein, are rare but often fatal. Objective: To evaluate outcomes and prognostic factors of polytetrafluoroethylene (PTFE) tube graft reconstruction for portal vein following severe portal triad injury during laparoscopic cholecystectomy. Methods: This prospective study analyzed seven patients who underwent portal vein reconstruction using PTFE tube grafts after severe portal triad injuries during laparoscopic cholecystectomy. Patients were referred from peripheral hospitals due to uncontrollable bleeding. Comprehensive statistical analyses were performed on survival outcomes, perioperative parameters, metabolic derangements, and postoperative complications. Results: Among the seven patients, five died within 72 h postoperatively (71.4% mortality), while two survived. Primary causes of death included hepatic failure, multiorgan dysfunction, and sepsis. Multivariate analysis identified three independent predictors of mortality: vascular clamp time >50 min (odds ratio [OR]: 5.8, P = 0.003), acute physiology and chronic health evaluation II score >25 (OR: 4.2, P = 0.007), and lactate >5 mmol/L at 12 h postoperatively (OR: 7.1, P < 0.001). Nonsurvivors demonstrated significantly elevated liver enzymes (aspartate transferase: 1842 ± 435 vs. 563 ± 172 IU/L, P < 0.001) and profound metabolic acidosis. Long-term follow-up of survivors (18–24 months) demonstrated excellent graft patency with minimal complications. Conclusion: PTFE tube grafts can be viable for portal vein reconstruction following severe portal triad injury, with survivors showing excellent long-term outcomes. Critical determinants of survival include vascular clamp time, severity of concurrent injuries, and timing of intervention. A multidisciplinary approach with standardized protocols for early recognition and rapid intervention may improve outcomes.