An assessment of surgery for portal hypertensive patients performed at a single community hospital

Tomikawa, Morimasa; Akahoshi, Tomohiko; Sugimachi, Keizō; Ikeda, Yasuharu; Korenaga, Daisuke; Takenaka, Katsuto; Hashizume, Makoto; Maehara, Yoshihiko

doi:10.1007/s00595-009-4123-5

Cited by 9 publications

(7 citation statements)

References 29 publications

(26 reference statements)

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“…24 Our fi ndings agree with those of other studies indicating that IPH patients tend to have a good prognosis: none of our patients died as a result of complications of portal hypertension. Although fi ve patients died, the causes of death were not related to variceal bleeding.…”

Section: Discussionsupporting

confidence: 93%

Implications of portal vein thrombosis after splenectomy for patients with idiopathic portal hypertension

et al. 2011

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Section: Discussionsupporting

confidence: 93%

Implications of portal vein thrombosis after splenectomy for patients with idiopathic portal hypertension

et al. 2011

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“…14 The ideal surgical treatment for patients with portal hypertension and refractory variceal bleeding should not only control bleeding effectively but also correct hypersplenism with little impairment of liver function. 5 We prefer performing OSED for patients with portal hypertension and severe gastroesophageal varices for 3 reasons: (1) this operation has been proved to be effective in controlling bleeding by a number of studies 15,16 ; (2) there is a very low incidence of encephalopathy or liver failure, and patients have a favorable long-term survival rate because of the maintenance of postoperative portal perfusion containing hepatotrophic factors, 17 which is an outstanding advantage when compared with TIPS; and (3) this procedure can also treat hypersplenism at the same time.…”

Section: Surgical Innovation 20(1)mentioning

confidence: 99%

“…1 Complications of hypersplenism, including decreased white blood cells (WBCs), platelets (Plts), and hemoglobin (Hb), can result in bleeding, infection, and anemia. 2 Open splenectomy and esophagogastric devascularization (OSED) has been widely used in the surgical treatment of portal hypertension in Asia 3,4 and can manage hypersplenism and prevent variceal bleeding. However, the liver function of patients with portal hypertension secondary to liver cirrhosis is usually very poor, and OSED is associated with a high morbidity and mortality.…”

mentioning

confidence: 99%

Laparoscopic Splenectomy and Esophagogastric Devascularization Is a Safe, Effective, Minimally Invasive Alternative for the Treatment of Portal Hypertension With Refractory Variceal Bleeding

2012

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Open splenectomy and esophagogastric devascularization (OSED) is a typical surgery for portal hypertension. Because of the high morbidity associated with it, it is desirable to develop a minimally invasive alternative. To investigate the safety and effect of laparoscopic splenectomy and esophagogastric devascularization (LSED), we performed LSED for 24 patients suffering from portal hypertension with refractory variceal bleeding while conducting OSED for 30 patients. The perioperative data and follow-up results were analyzed. Operation times were similar in both groups. Less intraoperative blood and faster return of gastrointestinal function were found in the LSED group. The LSED group had lower levels of alanine aminotransferase, aspartate aminotransferase, and total bilirubin after surgery. In both groups, the levels of platelet count, white blood cell count, or hemoglobin were increased after operation dramatically. During the follow-up period (range = 3-36 months), no patient had recurrent hypersplenism or variceal bleeding. Hence, LSED is a safe and minimally invasive intervention for portal hypertension with refractory variceal bleeding.

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“…[1,2] Once the varices are ruptured, the mortality is up to 15% to 20% within 6 weeks and as high as 40% within 1 year. [3,4] Liver transplantation is the most effective treatment for many chronic liver diseases with decompensated liver function. However, organ shortages and high medical costs appear to be 2 of the major problems in clinical transplantation.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of laparoscopic splenectomy and esophagogastric devascularization for portal hypertension

et al. 2018

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Many patients in China have portal hypertension secondary to liver cirrhosis. Splenectomy and devascularization have become an efficacious surgical procedure for portal hypertension, and has been recommended in China as the first choice for the treatment of portal hypertension for a long time. As a result of advances in laparoscopic equipment and techniques, splenectomy and esophagogastric devascularization have been carried out with laparoscope.From January 2012 to December 2017, 453 patients who were diagnosed with portal hypertension and serious gastroesophageal varices received surgical management in our institution. 250 patients chose laparoscopic splenectomy and esophagogastric devascularization and 203 underwent open splenectomy and esophagogastric devascularization.We retrospectively analyzed the perioperative data and follow-up data of these patients. The operation time of laparoscopic group was longer than open group (P ≤ .001). Intraoperative blood loss was less (P ≤ .001), the passing of flatus was earlier (P = .042), and postoperative hospital stay was shorter (P = .001) in the laparoscopic group. During postoperative follow-up of 4 to 75 months, the incidence of esophagogastric variceal rebleeding, encephalopathy, and secondary liver cancer showed no significant differences.Laparoscopic splenectomy and esophagogastric devascularization were safe and more effective than open surgery for portal hypertension and gastroesophageal varices.

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An assessment of surgery for portal hypertensive patients performed at a single community hospital

Abstract: Surgery for portal hypertensive patients performed at a single community hospital is still safe and effective, and has been adequately incorporated into the late treatment strategy for portal hypertensive patients.

Cited by 9 publications

References 29 publications

Implications of portal vein thrombosis after splenectomy for patients with idiopathic portal hypertension

Implications of portal vein thrombosis after splenectomy for patients with idiopathic portal hypertension

Laparoscopic Splenectomy and Esophagogastric Devascularization Is a Safe, Effective, Minimally Invasive Alternative for the Treatment of Portal Hypertension With Refractory Variceal Bleeding

Efficacy and safety of laparoscopic splenectomy and esophagogastric devascularization for portal hypertension

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