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


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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.

About the authors

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

References

  1. Gal'perin E.I., Diuzheva T.G., Rabinovich S.E. Distal'nyj
  2. splenorenal'nyj anastomoz. Hirurgicheskij podhod k
  3. echeniyu pacientov s saharnym diabetom. [The distal
  4. splenorenal anastomosis. The surgical approach to the
  5. treatment of diabetic patients]. Annaly khirurgicheskoi
  6. gepatologii, 1999; 2: 17-21. - (In Russian).
  7. Nazyrov F.G., Deviatov A.V., Ibadov R.A., Khashimov
  8. Sh.Kh. Rezul'taty lecheniya bol'nyh s cirrozom pecheni posle portosistemnogo shuntirovaniya [Results of treatment of patients with cirrhosis of the
  9. liver after portosystemic shunting]. Khirurgiia, 2008; 10:
  10. -35. - (In Russian).
  11. Torgunakov S. A. Klinicheskoe obosnovanie distal'nyh
  12. splenorenal'nyh venoznyh anastomozov "konec v konec" s perevyazkoj
  13. iz pochechnoj veny [Clinical substantiation of the distal
  14. splenorenal venous anastomosis "end to end" with ligation
  15. of the renal vein]. Aktual'nye voprosy sovremennoi
  16. khirurgii: materialy nauchno-prakticheskoi konferentsii
  17. [Actual problems of modern surgery: a scientific and
  18. practical materials]. Moscow-Krasnoyarsk, 2008, pp. 436-
  19. - (In Russian).
  20. Cowgill SM., Carey E., Villadolid D., Al-Saadi S., Zervos
  21. EE., Rosemurgy AS. Preshunt funkciya pecheni
  22. ostaetsya zametnym faktorom, opredelyayushchim vyzhivanie posle portosistemnogo shuntirovaniya [ Preshunt liver function remains the
  23. prominent determinant of survival after portasystemic
  24. shunting]. Am. J. Surg., 2006; 192(5): 617-21.
  25. Hashimoto N., Ashida H. Vliyanie distal'nogo
  26. splenorenal'nogo shunta
  27. plyus splenopankreaticheskoe raz"edinenie na glyukozu i amino-
  28. kislotnyj metabolizm [Effect of distal splenorenal shunt
  29. plus splenopancreatic disconnection on glucose and amino
  30. acid metabolism]. Hepatogastroenterology, 2005; 52: 61:
  31. –276.
  32. Henderson J.M. Distal'nyj splenorenal'nyj shunt v sravnenii transyaremnym
  33. vnutripechenochnym portalom sistematicheskij
  34. shunt dlya varikoznogo krovotecheniya pri
  35. randomizirovannom issledovanii [Distal splenorenal shunt versus transjugular
  36. intrahepatic portal systematic shunt for variceal bleeding: a
  37. randomized trial]. Gastroenterology, 2006; 130: 1643-1651.
  38. Kato K, Kondo S, Hirano S, Omi M, Ambo Y, Okushiba
  39. S, Katoh H. Hirurgicheskoe zakrytie shuntiruyushchego gastrorenal'nogo
  40. s distal'noj splenorenal'noj portosistemnoj operaciej shuntirovaniya pri
  41. ehncefalopatii [Surgical closure of the gastrorenal shunt
  42. with distal splenorenal shunt operation for portosystemic
  43. encephalopathy]. Hepatogastroenterology, 2001; 48(39):
  44. -1.
  45. Livingstone A.S., Koniaris L.G., Perez E.A. i drugie . 507
  46. Uorren-Zeppo distal'nye splenorenal'nye shunty, 34-letnij
  47. opyt [Warren‑Zeppa distal splenorenal shunts: a 34‑year
  48. Experience]. Ann. Surg., 2006; 243: 6: 884–892.
  49. Luca A., Garcia Pagan J.C., de Lacy AM. i drugie. Ehffekty konca v storonu portalo-kaval'nogo shunta i distal'nogo splenorenal'nogo shunta
  50. na sistemnoj i legochnoj gemodinamike u bol'nyh
  51. s cirrozom pecheni [ Effects of
  52. end‑to‑side porta‑caval shunt and distal splenorenal shunt
  53. on systemic and pulmonary haemodynamics in patients
  54. with cirrhosis]. Gastroenterol. Hepatol., 1999; 14:11: 1112–
  56. Uravic M., Depolo A., Dobrila-Dintinjana R. i drugie.
  57. Portosistemnye shunty-dvadcat' let
  58. nashego opyta [Portasystemic shunt-our twenty years experience]. Zentralbl
  59. Chir., 2002; 127(11): 971-4.

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