Rationale for Transthoracic Esophageal Transection for Bleeding Varices

Idezuki, Yasuo; Sugiura, Mitsuo; Sakamoto, Keisuke; Abe, Hideichi; Miura, Tsuyoshi; Hatano, Shigeru; Kimoto, S

doi:10.1378/chest.52.5.621

Cited by 17 publications

(10 citation statements)

References 9 publications

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“…40,41 To address the loss of shunt selectivity confirmed by the pancreatic vein during long-term followup in patients who undergo original DSRS, the DSRS is improved by adding splenopancreatic disconnection and gastric transection. 39,47,48 (3 Using a modified Walker's procedure, 58 esophageal transection in Japan was first carried out in 1967, 59 and refined by Sugiura and Futagawa in 1973. 54 After splenectomy, devascularization of the A catheter is selectively inserted into the splenic arterial branch.…”

Section: A) Shunting Proceduresmentioning

confidence: 99%

“…Various nonshunting procedures, such as Hassab's operation, esophageal transection, or terminal esophagoproximal gastrectomy, have been developed for the treatment of esophagogastric varices. [54][55][56][57][58][59] As most nonshunting procedures include splenectomy, portal vein thrombosis is not a rare complication. Using a modified Walker's procedure, 58 esophageal transection in Japan was first carried out in 1967, 59 and refined by Sugiura and Futagawa in 1973.…”

Section: B) Nonshunting Proceduresmentioning

confidence: 99%

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Management of portal hypertension based on portal hemodynamics

Yoshida

Shimizu

Yoshioka

et al. 2021

Hepatology Research

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Portal hypertension is most commonly caused by chronic liver disease. As liver damage progresses, portal pressure gradually elevates and hemodynamics of the portal system gradually change. In normal liver, venous returns from visceral organs join the portal trunk and flow into the liver (hepatopetal blood flow). As portal pressure increases due to liver damage, congestion of some veins of the visceral organ occurs (blood flow to and from). Finally, the direction of some veins (the left gastric vein in particular) of the visceral organ change (hepatofugal blood flow) and develop as collateral veins (portosystemic shunt) to reduce portal pressure. Therefore, esophagogastric varices serve as drainage veins for the portal venous system to reduce the portal pressure. In chronic liver disease, as intrahepatic vascular resistance is increased (backward flow theory) and collateral veins develop, adequate portal hypertension is required to maintain portal flow into the liver through an increase of blood flow into the portal venous system (forward flow theory). Splanchnic and systemic arterial vasodilatations increase the blood flow into the portal venous system (hyperdynamic state) and lead to portal hypertension and collateral formation. Hyperdynamic state, especially around the spleen, is detected in patients with portal hypertension. The spleen is a regulatory organ that maintains portal flow into the liver. In this review, surgical treatment, interventional radiology, endoscopic treatment, and pharmacotherapy for portal hypertension (esophagogastric varices in particular) are described based on the portal hemodynamics using schema.

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Section: A) Shunting Proceduresmentioning

confidence: 99%

Section: B) Nonshunting Proceduresmentioning

confidence: 99%

Management of portal hypertension based on portal hemodynamics

Yoshida

Shimizu

Yoshioka

et al. 2021

Hepatology Research

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“…13), whose approach with emergency shunts in his all-comers referral pattern population achieved remarkable results that others could not 37 Other surgical activity in this era brought attention to devascularization procedures of varying complexity and extent, most well-known being the procedure popularized by Mitsuo Sugiura (Fig. 14) in Tokyo (Japan), 39 who advocated a thoraco-abdominal procedure, 40 whereas Hector Orozco (Fig. 15) in Mexico City (Mexico) used a predominantly transabdominal approach, 41 and others varied their approach.…”

Section: Differing Approaches To Variceal Decompressionmentioning

confidence: 99%

The Surgical Treatment of Portal Hypertension

Henderson

Anderson

2020

Clinical Liver Disease

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Portal hypertension is a term that evokes varied responses among physicians: an opportunity for some and fear in others. Why is this? First, portal hypertension is associated with a broad range of clinical presentations such as variceal bleeding, ascites, encephalopathy, and end-stage liver disease. Second, the pathophysiology is complex with subtle nuances that may be crucial to the management of specific patients. And third, the treatment requires a broad-based team of specialists to define optimal management strategies. In this review, we will highlight pivotal historical phases of the management of portal hypertension with an emphasis on some of the key characters who traveled this path. But before we trace this story, let it be said that for almost a century portal hypertension was the domain of surgeons who built their reputations and careers in this arena with work that contributed to a better understanding of the field and was the basis of what was to come. Yet, as predicted by Hal Conn (Fig. 1) in 1989, 1 surgical portacaval shunting would no longer be the answer to portal hypertension in the 21st century. THe BeGinninGThe first documented publication in September 1877 of a portosystemic shunt was the animal study by the brilliant Abbreviations: HE, hepatic encephalopathy; PTFE, polytetrafluorethylene; TIPS, transjugular intrahepatic portosystemic shunts.

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“…Among non‐shunting procedures for the treatment of esophageal varices, ET has been the most popular operation. In Japan, ET was first performed in 1967, 38 using a modification of Walker's procedure for transthoracic ET 39 . The procedure was then refined by Sugiura and Futagawa in 1973 9 .…”

Section: Non‐shunting Proceduresmentioning

confidence: 99%

New trends in surgical treatment for portal hypertension

Yoshida

Mamada

Taniai

et al. 2009

Hepatology Research

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A number of surgical procedures have been developed to manage esophageal varices. Broadly, these can be classified as shunting and non‐shunting procedures. While total shunt effectively reduces the incidence of variceal bleeding, it is associated with a high risk of hepatic encephalopathy. The distal splenorenal shunt (DSRS), a selective shunt, was developed by Warren in 1967 to preserve portal blood flow through the liver while lowering variceal pressure. The hope was that both bleeding and hyperammonemia would be prevented. The DSRS effectively prevents rebleeding, but still carries a risk of hyperammonemia. We improved the DSRS procedure by additionally performing splenopancreatic disconnection (SPD, i.e. skeletonization of the splenic vein from the pancreas to its bifurcation at the splenic hilum) and gastric transection (GT, i.e. transection and anastomosis of the upper stomach with an autosuture instrument). An alternative to shunting was developed by Sugiura and Futagawa in 1973. Esophageal transection (ET) divides and reanastomoses the distal esophagus and devascularizes the distal esophagus and proximal stomach; splenectomy, selective vagotomy, and pyloroplasty are performed concomitantly. DSRS was more effective than ET in preventing recurrence of esophageal varices, but was associated with a higher incidence of hyperammonemia. The incidence of hyperammonemia in patients who underwent DSRS with SPD plus GT was significantly lower than that in patients who underwent DSRS alone or those who underwent DSRS with SPD. In conclusion, there are various surgical treatments for esophagogastric varices. Distal splenorenal shunt with SPD plus GT is considered an adequate treatment for patients with esophagogastric varices.

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Rationale for Transthoracic Esophageal Transection for Bleeding Varices

Cited by 17 publications

References 9 publications

Management of portal hypertension based on portal hemodynamics

Management of portal hypertension based on portal hemodynamics

The Surgical Treatment of Portal Hypertension

New trends in surgical treatment for portal hypertension

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