Liver Retraction Using n-Butyl-2-Cyanoacrylate (NBCA) Glue during Laparoscopic Splenectomy and Azygoportal Disconnection in Cirrhotic Patients

Abstract

Background Although liver retraction using n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery in noncirrhotic patients, there is still no consensus on its safety and feasibility for cirrhotic patients. In this study, we aimed to investigate the safety and effectiveness of liver retraction using NBCA glue during laparoscopic splenectomy and azygoportal disconnection (LSD) for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension. Methods Thirty-nine gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension patients were included in our study. We performed LSD in the presence of NBCA glue (n = 22, NBCA group) and absence of NBCA glue (n = 17, n-NBCA group), respectively. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the two groups. Results There was no mortality during the operation. One patient in non-NBCA group received open surgery due to parenchyma hemorrhage. Postoperative pleural effusion occurred in 2 cases of the NBCA group and 1 of the non-NBCA group. One showed left subphrenic abscess in the non-NBCA group. No postoperative bleeding occurred after 9-30 months of follow-up. The time of operation in NBCA group was significantly shorter than those in n-NBCA group (198.86±17.86 versus 217.81±20.25min, P<0.01). Blood loss in NBCA group was significantly lower than non-NBCA group (159.09±56.98 versus 212.50±88.51 ml, P<0.05). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased on day 1 after LSD and decreased to normal level on day 7 after LSD in both groups. There was no significant difference in postoperative hospitalization and liver function between the two groups. Conclusion Liver retraction using NBCA glue during LSD for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension is safe, effective, and feasible.

Developing protein arginine methyltransferase 1 (PRMT1) inhibitor TC-E-5003 as an antitumor drug using INEI drug delivery systems

“…Some papers have reported that NBCA is biodegradable, biocompatible, nontoxic, and used in some clinical applications. (Jang et al, 2017;Kong et al, 2018;Sugawara et al, 2019). N,N 0 -(Sulfonyldi-4,1-phenylene)bis(2-chloroacetamide) (TC-E-5003) is a selective protein arginine methyltransferase 1 (PRMT1) inhibitor (IC 50 ¼1.5 lM).…”

Efficacy Analysis of Gastric Coronary Venous TH Glue Embolization with Splenectomy for Treating Cirrhotic Portal Hypertension

“…22 This study was mainly based on the clinical manifestations of patients before and after surgery, such as bleeding, liver function, hepatic encephalopathy, etc., to observe the benefits of operation by self-control. [23][24][25][26] Both domestic and foreign reports have shown that the incidence of hepatic encephalopathy after shunting is not high. The rate in the report of Johnson et al 27 was 9.6%, and in a domestic report Zhen et al 28 cited that the incidence of hepatic encephalopathy was 2.5% and 4.1% respectively in 5 and 10 years after devascularization.…”

Liver retraction using n-butyl-2-cyanoacrylate glue during laparoscopic cholecystectomy

“…In our experiences, we proposed the use of n-butyl-2-cyanoacrylate glue (NBCA) to fix the thick “protrusion” of the liver leaf surface to the liver surface during LC. [ 6 ] The procedure contributes to the visualization of the gallbladder triangle. In this study, we aim to investigate the safety and effectiveness of NBCA as a means of fixing a thick “protrusion” on the square leaf surface of liver in LC.…”

“…Indeed, these methods are not suitable for the thick “protrusion” retraction of liver leaf surface. In our experiences, we proposed the use of n-butyl-2-cyanoacrylate glue (NBCA) to fix the thick “protrusion” of the liver leaf surface to the liver surface during LC [6] . The procedure contributes to the visualization of the gallbladder triangle.…”