The independent prognostic value of Perioperative HVPG measurements in patients with portal hypertension and received Laparoscopic splenectomy plus esophagogastric devascularization

Abstract

Background Hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing portal hypertension (PHT). Laparoscopic splenectomy plus esophagogastric devascularization (LSED) is an important surgery for treating PHT. However, the variation trend of HVPG after surgery is not clear. In addition, whether HVPG could provide precise prognostic information for patients undergoing surgery remains to be further studied. This study aimed to investigate the independent prognostic value of HVPG in LSED. Methods From January 2016 to March 2023, 134 patients with PHT underwent LSED at our hospital were retrospectively evaluated. The correlations between clinical indicators and history of upper gastrointestinal bleeding (UGIB) were analyzed. Among them, 57 patients remeasured postoperative HVPG. Postoperative alterations of HVPG and correlative factors, as well as the relationship between the HVPG and postoperative UGIB, were further investigated. Results In this study, we found that 93 patients with preoperative UGIB (16.27 ± 5.73mmHg) had a higher baseline HVPG than the other 41 patients without (14.02 ± 5.90mmHg) (P = 0.04). The mean postoperative HVPG significantly decreased (-3.57 ± 8.09 mmHg, P = 0.001) than baseline, 66% of patients (38/57) experienced the decreased HVPG-response after surgery. The baseline HVPG and preoperative CTP class B were associated with the decreased HVPG-response. Additionally, the patients with postoperative HVPG decreased>20% from baseline exhibited better recurrent hemorrhage-free survival rates than those without (log-rank, P = 0.013). Conclusion We found that LSED led to a significantly decreased HVPG, and patients with postoperative HVPG decreased >20% obtained better UGIB-free survival benefits than those without.