Ligation of the Splenic Artery in Patients With Portal Hypertension

Everson, Tilden C.; Cole, Warren H.

doi:10.1001/archsurg.1948.01240010158005

Cited by 23 publications

(6 citation statements)

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“…Blain AW was first to perform OSAL for the treatment of hypersplenism related to Banti's syndrome, later on it was applied for the treatment of complications related to cirrhosis. [ 9 10 11 ] LSAL has not been reported for the treatment of HIC; however it is reported for the treatment of conditions such as SA aneurysm. [ 12 ] LSAL may help in preservation of splenic functions along with alleviation of symptoms of HIC.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 8 ] Historically, open splenic artery ligation (OSAL) has been used for the palliation of hypersplenism and ascites related to portal hypertension and cirrhosis. [ 9 10 ] Laparoscopic splenic artery ligation (LSAL) may be a minimally invasive treatment option for the palliation of HIC; we hereby report our experience of ten such cases.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic splenic artery ligation for hypersplenism in cirrhosis: A case series

et al. 2016

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BACKGROUND:Splenectomy for the treatment of hypersplenism in patients with cirrhosis (HIC) is related with complications. Laparoscopic splenic artery ligation (LSAL) may be an alternative treatment option.AIMS:To evaluate safety and feasibility of LSAL in the treatment of HIC.PATIENTS AND METHODS:Retrospective analysis of prospectively collected data of ten patients with HIC who were treated with LSAL from October 2012 to February 2015.RESULTS:The median (range) age was 33.2 (13-56) years and sex distribution was equal. The median (range) leukocyte counts (×109/L) before, and at 3, 6 and 12 months after LSAL were 2.2 (0.8-8.2) and 5.65 (2.78-10.7), 4.7 (2.8-7.8) and 4.95 (3.4-7.7) respectively. The median (range) platelet counts (×109/L) before and at 3, 6 and 12 months after LSAL were 25.5 (11-65) and 75 (39-289), 74 (32-184) and 76 (56-251) respectively. Following LSAL, there was a significant improvement in total leucocyte count, platelet count and Model for End-Stage Liver Disease (MELD) score (P < 0.05). Two patients (20%) developed intraoperative bleeding and required conversion; one of these two patients developed splenic cyst that required radiological intervention. Four patients (40%) had post ligation syndrome (PLS) that was managed conservatively. During a median (range) follow-up of 19.5 (5-29) months, one patient (10%) required splenectomy due to inadequate response.CONCLUSION:LSAL is a safe and feasible treatment option for the palliation of symptomatic HIC, however, further prospective trials are necessary for confirmation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Laparoscopic splenic artery ligation for hypersplenism in cirrhosis: A case series

et al. 2016

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“…16 It has been reported that approximately 40% of PVF reduction can be possible with splenic artery ligation. 17 Currently, adequate PVF and PVP after reperfusion with GIM would be 240.5 ± 90.8 mL/min/100 g and < 15 mmHg, respectively, which might contribute to preventing SFSS in adult LDLT. 16…”

Section: Introductionmentioning

confidence: 96%

Optimal graft size in pediatric living donor liver transplantation: How are children different from adults?

Kasahara

Sakamoto

2023

Pediatric Transplantation

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BackgroundPediatric liver transplantation is an established treatment for end‐stage liver disease in children. However, it is still posing relevant challenges, such as optimizing the graft selection according to the recipient size. Unlike adults, small children tolerate large‐for‐size grafts and insufficient graft volume might represent an issue in adolescents when graft size is disproportionate.MethodsGraft‐size matching strategies over time were examined in pediatric liver transplantation. This review traces the measures/principles put in place to prevent large‐for‐size or small‐for‐size grafts in small children to adolescents with a literature review and an analysis of the data issued from the National Center for Child Health and Development, Tokyo, Japan.ResultsReduced left lateral segment (LLS; Couinaud's segment II and III) was widely applicable for small children less than 5 kg with metabolic liver disease or acute liver failure. There was significantly worse graft survival if the actual graft‐to‐recipient weight ratio (GRWR) was less than 1.5% in the adolescent with LLS graft due to the small‐for‐size graft. Children, particularly adolescents, may then require larger GRWR than adults to prevent small‐for‐size syndrome. The suggested ideal graft selections in pediatric LDLT are: reduced LLS, recipient body weight (BW) < 5.0 kg; LLS, 5.0 kg ≤ BW < 25 kg; left lobe (Couinaud's segment II, III, IV with middle hepatic vein), 25 kg ≤ BW < 50 kg; right lobe (Couinaud's segment V, VI, VII, VIII without middle hepatic vein), 50 kg ≤ BW. Children, particularly adolescents, may then require larger GRWR than adults to prevent small‐for‐size syndrome.ConclusionAge‐appropriate and BW‐appropriate strategies of graft selection are crucial to secure an excellent outcome in pediatric living donor liver transplantation.

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“…Blain in 1918 [114] recommended ligation of the splenic artery. Everson and Cole in 1948 [115] again recommended ligation of the splenic artery. Berman and associates in 1951 [116] presented experimental evidence in favor of ligation of both the hepatic and splenic arteries, and this procedure was performed in 6 cases and reported by Rienhoff in 1951 [I17].…”

Section: Direct Variceal Controlmentioning

confidence: 99%

Surgical treatment of portal hypertension: A historical perspective

Donovan

1984

World j. surg.

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Portal hypertension has been treated surgically by diversion of blood from the portal system, by interruption of the flow of blood to esophageal varices, or by direct obliteration of the varices. At the beginning of the twentieth century, portal diversion was achieved by omentopexy and, in a few patients, by the creation of a portacaval shunt. The latter operation was abandoned because of high mortality and morbidity rates, including shunt encephalopathy. In the 1940's, interest was renewed in the portacaval shunt. Improved understanding of hepatic physiology and the establishment of precise criteria for selection of cases for surgery resulted in a low operative mortality rate. The operation was highly successful in the control of hemorrhage from esophageal varices but was associated with an undesirable incidence of impairment of hepatic function. Currently, selective decompression of varices by the distal splenorenal shunt is under evaluation as a method of preventing variceal hemorrhage, while preserving hepatic function. Elimination of the threat of hemorrhage from varices by arterial ligation, sclerotherapy, or direct suture has been practiced for almost a century. The result remains one of temporary control with recurrent hemorrhage in the majority of cases.Ascites was formerly considered the dominant manifestation of portal hypertension. Currently, it is usually well controlled by diuretics. Surgery is reserved for the rare case of intractable ascites, often with hepatorenal syndrome. In such cases, a shunt is established between the peritoneal cavity and the systemic venous system, a procedure first performed early in this century.

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Ligation of the Splenic Artery in Patients With Portal Hypertension

Cited by 23 publications

References 4 publications

Laparoscopic splenic artery ligation for hypersplenism in cirrhosis: A case series

Laparoscopic splenic artery ligation for hypersplenism in cirrhosis: A case series

Optimal graft size in pediatric living donor liver transplantation: How are children different from adults?

Surgical treatment of portal hypertension: A historical perspective

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