Laparoscopic Distal Splenorenal Anastomosis

Abstract

Introduction: Esophagogastric bleeding is the most formidable complication of the portal hypertension syndrome. At acute bleeding from varicose veins of the esophagus and stomach, mortality reaches 40 to 50% and is accompanied with the high risk of early hemorrhage recurrence in 30-50 % of survivors. Portosystemic shunt surgery provides for radical decompression of the portal vein system and reliably prevent hemorrhage recurrence. Purpose: To assess the possibility and efficacy of the Distal Splenorenal Anastomosis (DSRA) with a minimally invasive laparoscopic approach. Methods: The study included 28 patients with portal hypertension syndrome who underwent laparoscopic DSRA. By the Child-Pugh scale, class A was 42.9%, class B - 57.1%. The indication for surgical decompression of the portal system was the ineffectiveness of repeated sessions of endoscopic ligation with recurrence of varicose veins of the esophagus (21.5%) and/or bleeding from them (46.4%) or the presence of varicose veins of the stomach (32.1%). Results: Mean surgery time was 294±86 minutes. The maximum blood loss was 211±55 ml. The access conversion was performed in 10.7% of cases. In the postoperative period, the patients were in ICU for 1-2 days. The hospital stay and in-patients treatment duration was 9.4±2.5 days. Both in the early and in the long-term follow-up, there were no cases of gastroesophageal bleeding and shunt thrombosis. The portosystemic encephalopathy developed in 12% of cases. The surgical decompression of the portal system was featured by a decrease in the degree of esophagus varication in the long-term period. The maximum follow-up period was 46 months. Conclusion: Minimally invasive laparoscopic DSRA in patients with portal hypertension syndrome is a possible, safe and effective alternative treatment option.