Minimally invasive surgical interventions in the treatment and prevention of bleeding from varicose veins of the esophagus and stomach

Abstract

Treatment and prevention of complications of portal hypertension today is a complex and unsolved problem of hepatosurgery. Mortality from esophageal-gastric bleeding (ESH) of portal genesis ranges from 22 to 100%. The aim of the study is to improve the results of the treatment and prevention of digestive haemorrhage in portal hypertension by optimize using of miniinvasive interventions. A retrospective analysis of the treatment results of 128 patients with cirrhosis of the liver, in which the predominant complication of portal hypertension resulted in bleeding from varicose veins of the esophagus and the stomach, and a high risk of its occurrence or recidivism have been carried out. Gastric laparoscopic devascularization with endoscopic ligation reduces the lethality from esophageal-gastric bleeding, compared to only ligation, for six months after the operation by 21.8% (÷² = 2.61; p = 0.106), 25.5% within a year (÷² = 2.75; p = 0.091), for two years after the 25.4% operation (÷² = 1.47; p = 0.225), for three years 25.5% (÷² = 0.43; p = 0.051). There is a statistically reliable lack of differences in the groups of patients after the traditional and endovideoxyric operations of the portocal bypass in terms of the reduction of the degree of VDEV (84.3 and 86.7%), which indicates the equivalent effect of the performed operations. A comparative study of selective portocaval anastomoses and TIPS found no reliable difference in the frequency of recurrent bleeding. Post-shunt encephalopathy, thrombosis, and stenosis of the shunt were more common in the transjugular intrahepatic portosistame shunt (p < 0.001), and survival in the group of surgical anastomosis was superior to that of TIPS. The above data indicate that the use of endoscopic, endovascular, endovision and endovision surgery, extracorporeal miniinvasive techniques is an integral part of the complex surgical treatment of patients with portal hypertension. Miniinvasive surgical treatments are required depending on the current clinical situation and the degree of liver-cell failure. Flexible and selective tactics make it possible to improve the results of treatment of patients with cirrhosis of the liver, complicated by portal hypertension (6 figs, bibliography: 14 refs).

Keywords

esophageal varicose veins / portal hypertension

References

[1] Akilov Kh. A., Nazyrov F. G. Prognosis of survival in cirrhosis of the liver and formation of groups of recipients for transplantation of the liver after Portosista bypass. Annaly khirurgicheskoy gepatologii. 2013; 5 (2): 7–10. Russian (Акилов Х. А., Назыров Ф. Г. Прогноз выживаемости при циррозе печени и формирование групп реципиентов для трансплантации печени после портосистемного шунтирования. Анналы хирургической гепатологии. 2013; 5 (2): 7–10).

[2] Ivashkin V. T., Mayevskaya M. V., Pavlov C. S. Clinical recommendations of the Russian Society for the Study of the Liver and the Russian Gastroenterological Association for the Treatment of Complications of Cirrhosis of the Liver. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016; 26 (4): 71–102. Russian (Ивашкин В. Т., Маевская М. В., Павлов Ч. С. Клинические рекомендации Российского общества по изучению печени и Российской гастроэнтерологической ассоциации по лечению осложнений цирроза печени. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2016; 26 (4): 71–102).

[3] Garbuzenko D. V. Haemorrhaging from varicoso-dilated veins of the esophagus and stomach in patients with cirrhosis of the liver: pathogenesis, prophylaxis, treatment. Chelyabinsk: Vostochnye Vorota Publisher; 2004. 68. Russian (Гарбузенко Д. В. Кровотечения из варикозно расширенных вен пищевода и желудка у больных циррозом печени: патогенез, профилактика, лечение. Челябинск: Восточные Ворота; 2004. 68).

[4] Kashchenko V. A., Raspereza D. V., Shcherbakov P. Yu. Bleed portal genesis: past and present. Clinical Hospital. 2012; 1 (1): 124–7. Russian (Кащенко В. А., Распереза Д. В., Щербаков П. Ю. Кровотечения портального генеза: прошлое и настоящее. Клиническая больница. 2012; 1 (1): 124–7).

[5] Shertsinger A. G., Zhigalova S. B., Musin R. A. Endoscopic ligation of varicoso-diluted esophageal veins in patients with portal hypertension. Annaly khirurgicheskoy gepatologii. 2010; 10 (1): 62–6. Russian (Шерцингер А. Г., Жигалова С. Б., Мусин Р. А. Эндоскопическое лигирование варикозно расширенных вен пищевода у больных портальной гипертензией. Анналы хирургической гепатологии. 2010; 10 (1): 62–6).

[6] Salama I. A., Helmy A., Connolly R., Schwaitzberg S. D. Laparoscopic devascularization of the lower esophagus and upper stomach: Experimental study in the pig. J. Laparoendosc. Adv. Surg. Tech. A. 2003; 13 (1): 59–63.

[7] Yeramishantsev A. K., Musin P. A., Lyubivy E. D. Portocaval bypass or stitching varicoso-dilated veins of the esophagus and stomach. What to choose? Annaly khirurgicheskoy gepatologii. 2015; 10 (2): 76–7. Russian (Ерамишанцев А. К., Мусин P. A., Любивый Е. Д. Портокавальное шунтирование или прошивание варикозно расширенных вен пищевода и желудка. Что выбрать? Анналы хирургической гепатологии. 2015; 10 (2): 76–7).

[8] Branch-Elliman W., Perumalswami P., Factor S. H., Sled S. M., Flamm S. L. Rates of recurrent variceal bleeding are low with modern esophageal banding strategies: a retrospective cohort study. Scand. J. Gastroenterol. 2015; 50 (9): 1059–67.

[9] Tarazov P. G., Polykarpov A. A., Granov D. A. Transjugular portocaval shunt as a stage of preparation for liver transplant. Materials nauch. Prakt. concf. (international participation): «Innovation in a modern federal multidisciplinary medical science center». Saint Petersburg; 2013: 172. Russian (Таразов, П. Г., Поликарпов А. А., Гранов Д. А. Трансъюгулярный внутрипеченочный портокавальный шунт как этап подготовки к трансплантации печени. Материалы науч.-практ. конф. (с междунар. участием): «Инновации в современном федеральном мультидисциплинарном медицинском научном центре». СПб.; 2013: 172).

[10] Altun R., Yıldırım E., Ocal S., Akbaş E., Harman A., Kormaz M., Selçuk H. Transjugular intrahepatic portosystemic shunt: Where are we? Turk. J. Gastroenterol. 2014; 25 (3): 298–303.

[11] Zubarev P. N. Development of the idea of surgical treatment of patients with portal hypertension at the Military Medical Academy. Saint Petersburg: VMedA Publisher; 2000. 24. Russian (Зубарев П. Н. Развитие идеи хирургического лечения больных портальной гипертензией в Военно-медицинской академии. СПб.: ВМедА; 2000. 24).

[12] Nazyrov F. G., Devyatov A. V., Babadzhanov A. Kh. Comparative analysis of the results of distal splenial anastomosis in patients with portal hypertension. Novosti khirurgii. 2011; 19 (5): 52–9. Russian (Назыров Ф. Г., Девятов А. В., Бабаджанов А. Х. Сравнительный анализ результатов дистального спленоренального анастомоза у пациентов с портальной гипертензией. Новости хирургии. 2011; 19 (5): 52–9).

[13] Helmy A., Abdulkader Salama I., Schwaitzberg S. D. Laparoscopic esophagogastric devascularization in bleeding varices. Surg. Endosc. 2003; 17: 1614–9.

[14] Danis J., Hubmann R., Pichler P., Shamiyeh A., Wayand W. U. Novel technique of laparoscopic azygoportal disconnection for treatment of esophageal varicosis: preliminary experience with five patients. Surg. Endosc. 2004; 18 (4): 702–5.

RIGHTS & PERMISSIONS

Kotiv B.N., Dzidzava I.I., Alentyev S.A., Zubarev P.N., Onnicev I.E., Khokhlov A.V., Muzharovskiy A.L., Yankovskiy A.