The Results of an Original Method Restrictions of Portocaval Reset in the Formation of the Distal Splenorenal Shunt in Patients with Liver Cirrhosis

Abstract


Relevance In patients with liver cirrhosis (LC) with portal hypertension (PH) distal splenorenal shunt (DSRS) is one of the best types of portosystemic shunting. However, despite its universality and a lot of research on the positive evaluation, remain unresolved issues before the end of the potential of this type of decompression in a pronounced expansion of the splenic vein and the likelihood of developing of deportalisation of portal pool. Materials and methods Developed method of restrictions of portocaval reset in DSRS in patients with severe transformation of the splenic vein with restrictive cuff made from Dacron graft. To compare the results of DSRS with restrictive cuff formed three groups of 231 patients: DSRS with splenic vein diameter 1,5 cm - 194; DSRS with splenic vein diameter greater than 1,5 cm without restrictions - 21; DSRA with splenic vein diameter greater than 1,5 cm with a limited - 14. Results and their discussion The incidence of liver failure was higher in patients where the diameter veins more than 1.5 cm and the restrictive cuff does not applied – 14,3%, whereas the use of an original method reduced the risk of this complication to 6.3%. In the group of patients with splenic vein diameter less than 1,5 cm is a complication observed in 3,1% of cases. The frequency of ascites was 23,8% - in the group of patients with a wide vein without limitation, 12,5% - by using restrictive cuffs and 13,9% - in the group with splenic vein diameter to 1,5 cm. Bleeding from varices of the esophagus and stomach in the early period after DSRS developed in 14,3% of patients with splenic vein more than 1,5 cm, and 3,1% of the diameter veins up to 1,5 cm in the group with restrictive DSRS. Mortality also was the highest in the group with no restrictions DSRS – 9,5% vs. 4,1% and 0% in the other groups. Conclusion The introduction of an original technique of restrictions of portocaval reset in DSRS in patients with severe transformation of the splenic vein in the formation of DSRS, reduced the risk of thrombosis of anastomosis, as well as a full deportalisation of the liver in the remote period.

Republican Specialized Centre of Surgery named after acad. V.Vakhidov, Tashkent, Uzbekistan

Author for correspondence.
Email: author@vestnik-surgery.com
Director of RSCS named after akad.V.Vahidov, MD, professor, head of department of surgery of the liver, biliary tract, pancreatoduodenal zone and portal hypertension, Honored Worker of Health of the Republic of Uzbekistan, the vicepresident of the Association of Surgeons-hepatologists CIS countries, Academician of RANS.

Republican Specialized Centre of Surgery named after acad. V.Vakhidov, Tashkent, Uzbekistan

Email: author@vestnik-surgery.com
chief scientist at the Department of Surgery of portal hypertension and pancreatoduodenal zone RSCS, im. akad. V.Vahidova, MD, PhD

Republican Specialized Centre of Surgery named after acad. V.Vakhidov, Tashkent, Uzbekistan

Email: author@vestnik-surgery.com
Senior Research Fellow Department of Surgery of portal hypertension and pancreatoduodenal zone RSCS named after akad.V.Vahidov, PhD.

Republican Specialized Centre of Surgery named after acad. V.Vakhidov, Tashkent, Uzbekistan

Email: author@vestnik-surgery.com
surgeon of Department of Surgery of portal hypertension and pancreatoduodenal zone RSCS named after akad.V.Vahidov

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