Laparoscopic esophagogastric devascularization in bleeding varices

Helmy, A.; Salama, Ibrahim; Schwaitzberg, S. D.

doi:10.1007/s00464-002-8928-1

Cited by 18 publications

(14 citation statements)

References 14 publications

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“…In addition, it is difficult to remove the extremely enlarged spleen because of its higher conversion rate [14] . Less invasive laparoscopic devascularization of the lower esophagus and upper stomach was performed partly through experimentation [15] or minilaparotomy [16][17][18][19][20][21] . In this study, success of laparoscopic splenectomy and azygoportal disconnection was achieved in all but 2 patients.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension

Jiang

Zhao²,

Hong³

et al. 2009

WJG

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AIM:To compare the outcomes of laparoscopic and open splenectomy and azygoportal devascularization for portal hypertension. METHODS:From June 2006 to March 2009, laparoscopic splenectomy and azygoportal disconnection (LSD) were performed on 28 patients with cirrhosis, bleeding due to portal hypertension, and secondary hypersplenism. Success was achieved in 26 patients. Demographic, intraoperative, and postoperative variables of the patients were compared. RESULTS:Success of laparoscopic splenectomy and azygoportal disconnection was achieved in all but two patients (7.14%) who required open splenectomy and azygoportal devascularization (OSD). The operation time was significantly longer in patients undergoing LSD than in those undergoing OSD (235 ± 36 min vs 178 ± 47 min, P < 0.05). The estimated intraoperative blood loss was much more in patients receiving OSD than in those receiving LSD (420 ± 50 mL vs 200 ± 30 mL, P < 0.01). The proportion of patients undergoing laparoscopic and open splenectomy and azygoportal disconnection who received transfusion of packed red blood cells during or after the operation was 23.08% and 38.46%, respectively (P < 0.05). The time of first oral intake was faster in patients after LSD than in those after OSD (1.5 ± 0.7 d vs 3.5 ± 1.6 d, P < 0.05). The hospital stay of patients after LSD was shorter than that of patients after OSD (6.5 ± 2.3 d vs 11.7 ± 4.5 d, P < 0.05). The pain requiring medication was less severe in patients after LSD than in those after OSD (7.69% vs 73.08%, P < 0.001). The overall complication rate was lower in patients after LSD than in those after OSD (19.23% vs 42.31%, P < 0.05). CONCLUSION:Laparoscopic splenectomy and azygoportal disconnection are the feasible, effective, and safe surgical procedure, and are advantageous over minimally invasive surgery for bleeding portal hypertension and hypersplenism.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension

Jiang

Zhao²,

Hong³

et al. 2009

WJG

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“…У 50-85 % пациентов цирроз печени осложняется портальной гипертензией, одним из проявлений которой является варикозное расширение вен пищевода (ВРВП) [3,4]. Уже первый эпизод кровотечения из ВРВП может привести у 50-70 % больных к летальному исходу [2,[8][9][10]. Возрастающая заболеваемость циррозом печени, осложненным портальной гипертензией с кровотечением из ВРВП, отличающемся высокой летальностью, позволяет считать эту проблему актуальной для современной хирургии и требует усовершенствования существующих способов профилактики и хирургического лечения [1].…”

Section: вопросы общей и частной хирургииunclassified

Surgical Methods of Bleeding Prevention From Esophageal Varices in Treatment for Patients With Liver Cirrhosis

Zarivchatsky¹,

Каменских²,

Мугатаров³

et al. 2017

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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Кафедра факультетской хирургии № 2 с курсом гематологии и трансфузиологии (зав. -проф. М. Ф. Заривчацкий), ФДПО ФГБОУ ВО «Пермский государственный медицинский университет им. акад. Е. А. Вагнера» Минздрава России ЦЕЛЬ ИССЛЕДОВАНИЯ. Улучшить результаты хирургического лечения больных с циррозом печени с угрозой кровотечения из варикозно-расширенных вен пищевода. МАТЕРИАЛ И МЕТОДЫ. В исследование включили 90 больных с варикозным расширением вен пищевода (ВРВП). Портокавальное шунтирование выполнено 21 пациенту, прямые вмешательства на венах пищевода и желудка -29, эндоскопическое лигирование вен пищевода -40. РЕЗУЛЬТАТЫ. Показатель кумулятивной выживаемости больных после портокавального шунтирования до 1 года составил (93,3±6,4) %, до 3 лет -(66,7±12,2) % и 5 лет -(60±12,7) %, после прямых вмешательств на венах пищевода (92,9±6,9) 5±18,5) % соответственно. ЗАКЛЮЧЕНИЕ. Для профилактики кровотечений из варикозно-расширенных вен методом выбора являются курсы эндоскопического лигирования вен. Ключевые слова: цирроз печени, портальная гипертензия, варикозное расширение вен пищевода, рецидив кровотечения OBJECTIVE. The authors would like to improve the results of surgical treatment of patients with threat of bleeding from esophageal varices. MATERIALS AND METHODS. The study included 90 patients with esophageal varices on the background of liver cirrhosis. Portocaval bypass was performed on 21 patients. The direct interventions on the stomach and esophageal varices were carried out in 29 patients. The endoscopic ligation of esophageal varices was used in 40 cases. RESULTS. The rate of cumulative survival after portocaval bypass was 93,3±6,4 % (up to1 year), 3-year survival rate counted 66,7±12,2 % and 5-year rate was 60,0±12,7 % , respectively. The rate of survival after direct interventions on the stomach and esophageal varices consisted of 92,9 %±6,9 %, 76,0±12,2 % and 65,1±14,5 %, respectively. The survival rate after the endoscopic ligation of esophageal varices class A and B in Child-Pugh numbered 100 %, 91,0±8,7 % and 54, 6±20,6 %, but in case of the class C survival rate counted 60,0±20,4 %, 45,0 %±18,8 and 22,5±18,5 %, respectively. CONCLUSIONS. The authors recommend to apply the long-term courses of endoscopic ligation of esophageal varices in order to prevent bleeding from them. The methods of portcaval bypass or direct intervention should be used in case of lack of effect of endoscopic ligation method.

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“…Die Splenektomie ist offenbar nicht essenziell bei diesen Verfahren [41]. Die laparoskopische Durchführbarkeit von ösophagogastralen Devaskularisationen ist erfolgreich gezeigt worden [20].…”

Section: Devaskularisationsoperationenunclassified

Chirurgische Therapie der portalen Hypertension

Wolff

Hirner²

2005

Zentralbl Chir

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A switch to decompressive shunt procedures is mandatory if endoscopic therapy fails to control recurrent variceal hemorrhage. Surgical shunt procedures continue to be safe, highly effective and durable procedures to control variceal bleeding in patients with low operative risk and good liver function (Child A). In cirrhotics, elective operations using portal flow preserving techniques such as a selective distal splenorenal shunt (Warren) or a partial portocaval small diameter interposition shunt (Sarfeh) should be preferred. Rarely, end-to-side portocaval shunt may serve as a salvage procedure if emergent endoscopic treatment or TIPS insertion fail to stop bleeding. Until definitive results from randomized trials are available patients with good prognosis (Child-Pugh A and B) can be regarded as candidates for surgical shunts. For patients with noncirrhotic portal hypertension, in particular with extrahepatic portal vein thrombosis, portosystemic shunt surgery represents the only effective therapy which leads to freedom of recurrent bleeding and repeated endoscopies for many years, and improves hypersplenism without deteriorating liver function or encephalopathy. Gastroesophageal devascularization and other direct variceal ablative procedures should be restricted to treat endoscopic therapy failures without shuntable portal tributaries.

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Laparoscopic esophagogastric devascularization in bleeding varices

Abstract: Laparoscopic devascularization of the lower esophagus and the upper stomach is technically feasible and promising. Rapid recovery and control of variceal hemorrhage are accomplished in most patients without exposing them to the risk of open surgery.

Cited by 18 publications

References 14 publications

Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension

Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension

Surgical Methods of Bleeding Prevention From Esophageal Varices in Treatment for Patients With Liver Cirrhosis

Chirurgische Therapie der portalen Hypertension

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