Intra-hepatic Shunt Evaluated by Serum Ammonia Level. Closing of Porto-systemic Shunt.

Ohtsubo, Takehito; Takasaki, Ken; Tsugita, Masashi; Yamamoto, Masakazu; Suzuki, Takafumi; Miyazaki, Syoujiro; Nakagami, Tetsuo

doi:10.5833/jjgs.29.2265

Cited by 2 publications

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“…The post-clamping PVP < 20 cmH 2 O points away from portal hypertension. In view of the fact that obliteration of a portosystemic shunt in cases of Child-Pugh A or B hepatic impairment increases the PVP by < 60% [13], the criteria we are proposing are quite strict. We must bear in mind, however, that the chief consideration is avoidance of complications after surgery, especially those that can result in death.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Intraoperative Measurement of Portal Venous Pressure for Confirming the Most Appropriate Hepatectomy in Patients with Borderline Hepatic Functional Reserve

Koizumi

Nakano

Kobayashi

et al. 2015

J St. Marianna Univ

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Background We investigated whether portal venous pressure (PVP) measured immediately before surgery and then immediately after clamping of the Glissonian pedicle can be used to predict postoperative complications (ascites or jaundice) and thus select the extent of resection in patients with liver disease requiring hepatectomy. Methods Thirty-seven patients with hepatic functional reserve near the advisable limit and in whom direct measurement of PVP was done just before surgery and after clamping of the Glissonian pedicle were divided into two groups, an Event group (n = 9) and a Non-event group (n = 28), according to whether postoperative complications developed. The relation between PVP and the complication rate was analyzed, and a PVP safety margin was identified. Results PVP obtained after the Glissonian pedicle was clamped was significantly higher in the Event group than in the Non-event group (18.8 vs. 15.7 cmH 2 O; p = 0.03). The PVP gradient (defined as PVP after Glissonian clamping -PVP before surgery) tended to be greater in the Event group (5.1 versus 3.6 cmH 2 O; p = 0.13). PVP after Glissonian clamping plotted against the PVP gradient revealed safety margins of PVP gradient < 5 cmH 2 O and PVP < 20 cmH 2 O, respectively. Conclusion PVP after Glissonian clamping and the PVP gradient may be useful for predicting post-hepatectomy complications.

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Section: Discussionmentioning

confidence: 99%

Usefulness of Intraoperative Measurement of Portal Venous Pressure for Confirming the Most Appropriate Hepatectomy in Patients with Borderline Hepatic Functional Reserve

Koizumi

Nakano

Kobayashi

et al. 2015

J St. Marianna Univ

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Surgical Shunt Closure via the Lumen of an Intrahepatic Portal Aneurysm

Ariizumi

Takasaki²,

Yamamoto³

et al. 2006

Dig Surg

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Background/Aims: A surgical shunt closure via the lumen of an intrahepatic portal aneurysm was successfully performed in a 70-year-old Japanese woman with hepatic encephalopathy due to hyperammonemia. She had a 4-month history of repeated hepatic encephalopathy which persisted after treatment with oral medicine. Color Doppler ultrasonography and computed tomography revealed a cystic peripheral portal aneurysm, 4 cm in diameter, connecting the posterior branch of the portal vein to the short hepatic vein in the right lobe. Methods: While performing the Pringle maneuver and clamping the inferior vena cava below the liver, the wall of the portal aneurysm was opened, and the site of inflow from the portal vein and the site of outflow to the hepatic vein via the lumen of the portal aneurysm were closed with interrupted sutures. Results: The patient’s postoperative course was uneventful, and she was discharged 12 days after surgery. 12 months after surgery, she had no recurrence of hyperammonemia or hepatic encephalopathy. Conclusion: Surgical shunt closure via the lumen of a portal aneurysm can be performed safely, easily, and completely with good vision.

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Intra-hepatic Shunt Evaluated by Serum Ammonia Level. Closing of Porto-systemic Shunt.

Cited by 2 publications

References 0 publications

Usefulness of Intraoperative Measurement of Portal Venous Pressure for Confirming the Most Appropriate Hepatectomy in Patients with Borderline Hepatic Functional Reserve

Usefulness of Intraoperative Measurement of Portal Venous Pressure for Confirming the Most Appropriate Hepatectomy in Patients with Borderline Hepatic Functional Reserve

Surgical Shunt Closure via the Lumen of an Intrahepatic Portal Aneurysm

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