CORRECTION OF HYPERSPLENISM IN PORTAL HYPERTENSION SURGERY

Abstract

Aim. The aim of the study was to investigate the efficiency of the distal splenorenal anastomoses without splenic artery ligation as well as Sugiura-Futagawa surgery in correction of hypersplenism. Materials and methods. Sixty six patients were operated for hepatic cirrhosis (HC) of various etiology, portal hypertension (PH), complicated by esophageal varicose veins dilatation (EVVD), hypersplenism. There were 36 men and 30 women. The patients’ age ranged from 16 to 69 years with a mean age of 40,13 ± 9,03 years. Forty five patients, urgently hospitalized in connection with continued hemorrhage from the EVVD or immediately after it, in case of ineffective conservative and endoscopic treatment underwent Sugiura-Futagawa surgery, modified by us. Results. Sugiura-Futagawa surgery with splenectomy permits to correct all the symptoms of hypersplenism in the early and long-term postoperative periods. After applying distal splenorenal anastomoses without splenic artery ligation, the number of leucocytes significantly increased just after the surgery, and one year later there was only a tendency to rise in the amount of platelets and erythrocytes compared to the preoperative level. Conclusions. Predictors of hypersplenism correction in the long-term period following the portal system decompressing surgery are the initial erythrocyte and leukocyte levels, transaminase activity, portal volumetric blood circulation.

Keywords

Hypersplenism / portal hypertension / distal splenorenal ananstomosis / Sugiura-Futagawa surgery

References

[1] Алентьев С.А., Лазуткин М.В., Дзидзава И.И. Коррекция гиперспленизма у больных с внепеченочной формой портальной гипертензии. Анналы хирургической гепатологии 2006; 11 (3): 159.

[2] Лазуткин М.В. Хирургическая коррекция гиперспленизма у больных портальной гипертензией: автореф. дис. … канд. мед. наук. СПб. 2006; 21.

[3] Троян В.В., Заполянский А.В., Колесников Э.М. Синдром портальной гипертензии у детей: учебно-методическое пособие. Минск: БелМАПО 2009; 58.

[4] Bai D.S., Qian J.J., Yao J., Wang X.D., Jin S.J., Jiang G.Q. Modified laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension. Surg Endosc 2014; 28 (1): 257-264.

[5] Chaudhary N., Mehrotra S., Srivastava M., Nundy S. Management of bleeding in extrahepatic portal venous obstruction. Int J Hepatol 2013; 784-842. DOI: 10.1155/2013/784842

[6] Cai Y., Liu X., Peng B. A novel method for laparoscopic splenectomy in the setting of hypersplenism secondary to liver cirrhosis: ten year’s esperience. World J Surg 2014; 38 (11): 2934-2999.

[7] Chen X.D., He F.Q., Yang Y.Y., Zhou Z.G. Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review. ANZ J Surg 2013; 83 (3): 122-128.

[8] Helaly A.Z., Al-Warraky M.S., El-Azab G.I., Kohla M.A., Abdelaal E.E. Portal and splanchnic hemodynamics after partial splenic embolization in cirrhosis patients with hypersplenism. APMIS 2015; 123 (12): 1032-1039.

[9] Hadduck T.A., McWilliams J.P. Partial splenic artery embolization in cirrhosis parients. World J Surg 2014; 6 (5): 160-168.

[10] Zhan X-L., Ji Y., Wang Y-D. Laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension. World J Gastroenterol 2014; 20 (19): 5794-5800.

[11] Yamamoto N., Okano K., Oshima M., Akamoro S., Fujiwara M. Laparoscopic splenectomy for patients with liver cirrhosis: improvement of liver function in patients with Child-Pugh class B. Surgery 2015; 158 (6): 1538-1544.

RIGHTS & PERMISSIONS

Kotelnikova L.P., Mukhamadeev I.S., Burnyshev I.G., Stepanov R.A., Fedachuk N.N.