A prospective randomized trial of selective versus nonselective esophagogastric devascularization for portal hypertension

Abstract

Cirrhosis with portal hypertension is a common disease which has a significant impact on the quality of patients’ life. Esophagogastric devascularization (EGDV) has been demonstrated to be an effective method to treat portal hypertension, however certain complications are associated with it. The purpose of this study was to evaluate the effectiveness and clinical outcome of the selective EGDV (sEGDV) for the treatment of portal hypertension. The study was conducted prospectively from Jan. 1 2011 to Dec. 31, 2012, and 180 patients were randomized to the sEGDV group (n=90) or the non-sEGDV (n-sEGDV) group (n=90). Patients’ demographics, preoperative lab test results and operative details were comparable between the two groups. Postoperative and short-term complications were analyzed in two groups. There was statistically significant difference (P<0.01) in the PVF reduction between the two groups. Post-operative complications showed no statistically significant difference between the two groups in the incidence of bleeding, ascites, acute portal vein thrombosis, fever and hepatic encephalopathy. Mortality between two groups was comparable. The incidence of splenic fossa effusion after the surgery was lower in sEGDV group than in n-sEGDV group. There were no significant differences in the short-term follow-up data such as esophageal varices and portal hypertensive gastropathy (P>0.05). It is suggested that sEGDV is a safe, simple and effective surgical procedure. It has both the advantages of the shunt and devascularization because it preserves body’s voluntary diversion. With the advantage of low incidence of postoperative complications, it is an ideal surgical approach for the treatment of portal hypertension.

Keywords

portal hypertension / selective esophagogastric devascularization / efficacy

References

[1] YangZ, QiuFZ. The typical technique of pericardial devascularization and its effects on portal hypertension. Huazhong Yixue Zazhi (Chinese), 2001, 25(5): 229-230

[2] ZhouGW, LiHW. Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects. Chin Med J, 2009, 122(13): 1483-1485

[3] JiangHC, SunB, QiaoHQ, et al.. Modified Sugiura procedure for the treatment of portal hypertension in 85 cases. Chin J Oper Proc Gen Surg (Electronic Version), 2009, 3(3): 20-22

[4] CorbettC, MangatK, OlliffS, et al.. The role of transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the management of variceal hemorrhage. Liver Int, 2012, 32(10): 1493-1504

[5] FullwoodD. Portal hypertension and varices in patients with liver cirrhosis. Nurs Stand, 2012, 26(48): 52-57

[6] ZhangN, YuJH, XuGL. Clinical application of the selective devascularization. J Hepatobiliary Surg, 2011, 19(3): 235-237

[7] YangZ. Anatomy naming and steps of selective periesophagogastric devascularization. J Surg Concepts Pract, 2009, 14(1): 82-85

[8] YangZ. . The latest surgical treatment of portal hypertension, 2005, Jinan, Shandong Science and Technology Publishing House, 472-473

[9] McCormackTT, SimsJ, Eyre-BrookI, et al.. Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy?. Gut, 1985, 26(11): 1226-1232

[10] LiSL, LiYC, XuWL, et al.. Laparoscopic splenectomy and periesophagogastric devascularization with endoligature for portal hypertension in children. J Laparoendosc Adv Surg Tech A, 2009, 19(4): 545-550

[11] ShiB, YangZ, WangX, et al.. Selective periesophagogastric devascularization in portal hypertension: results of 56 patients. Hepatogastroenterology, 2009, 56(90): 492-497

[12] WuZY. Hemodynamic study of portal hypertension. Hepatobiliary Pancreal Dis Int, 2007, 6(5): 457-458

[13] WangC, YangZ, XiaoL, et al.. Prevention of postoperative portal vein thrombosis in patients undergoing selective periesophagogastric devascularization combined with omentorenopex. J Surg Concepts Pract, 2009, 14(5): 543-545

[14] YangZ. . Portal hypertension surgery atlas, 2006, Shen Yang, Liao Ning Science Technology Publishing House, 198-223