Laparoscopic selective esophagogastric devascularization and splenectomy for patients with cirrhotic portal hypertension.

Abstract

Introduction The role of laparoscopic selective esophagogastric devascularization and splenectomy (LSEGDS) in the treatment of esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension has not been well studied. Aim To investigate the safety and efficacy of LSEGDS for esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension. Material and methods From May 2011 to December 2014, 74 patients with portal hypertension resulting from liver cirrhosis underwent surgery for gastroesophageal variceal bleeding and hypersplenism. Forty-one of these patients underwent laparoscopic esophagogastric devascularization and splenectomy (LEGDS), and the others underwent LSEGDS. A retrospective comparative analysis of clinical data was conducted between the two groups, including clinical characteristics, laboratory data, operative morbidity and mortality, and outcomes of follow-up. Results The operation was completed successfully in all the patients, except that conversion was required in one patient in the LEGDS group. The operating time was similar in both groups (p = 0.579). The intraoperative blood loss was lower in the LSEGDS group (p = 0.011). Postoperative complications showed no significant difference between the two groups regarding mortality rate, pleural effusion, pancreatic injury, pulmonary infection, liver dysfunction, or postoperative abdominal bleeding. Postoperative platelet counts increased significantly more in the LEGDS group than in the LSEGDS group (p = 0.004). There were no significant differences in the long-term follow-up data, such as incidence of rebleeding, portal vein thrombosis, hepatic encephalopathy and survival (p > 0.05). Conclusions The LSEGDS is a safe and effective procedure for management of cirrhotic portal hypertension, especially in patients with visible paraesophageal veins.

Transjugular intrahepatic portosystemic shunt: a meta-analysis of 8 mm versus 10 mm stents.

“…TIPS dysfunction was defined as > 50% intra-stent stenosis, portal hypertensive complication recurrence, or a PPG > 12 mm Hg [ 16 ]. Portal hypertensive complications primarily included variceal bleeding, refractory ascites, hepatorenal syndrome, and hepatopulmonary syndrome [ 1 – 5 ]. Variceal bleeding was defined as the finding, at esophagogastroduodenoscopy, of ongoing or recent variceal hemorrhage or the finding of blood in the stomach and the presence of varices as the only potential cause of bleeding [ 18 ].…”

“…Portal hypertension is the pivotal vascular consequence of end-stage liver disease leading to severe complications, such as variceal bleeding and ascites [ 1 ]. Transjugular intrahepatic portosystemic shunt (TIPS) is an approach that is used to alleviate portal hypertension-related symptoms including variceal bleeding, hepatorenal syndrome, refractory ascites, and hepatopulmonary syndrome [ 2 – 5 ].…”

Long-term outcomes of synchronous splenectomy and hepatectomy or radiofrequency ablation for hepatocellular carcinoma and esophagogastric variceal bleeding

“…Pericardial devascularization (PCDV) plus splenectomy is widely used to treat patients with variceal bleeding. For patients with Child's A or B stage, PCDV is not inferior to TIPS in terms of treating portal hypertension and recurrent variceal bleeding and preventing rebleeding 11 , which is a safe and effective treatment 12 .…”

Surgical Tactics for Failure of Stapler Esofago-Esofagoanastomosis During Esophagastric Devascularization

“…В настоящее время в клинической практике достаточно широко используются лапароскопические модификации азигопортального разобщения по методике Hassab [25,26,27].…”