Abstract
Aim Portal hypertension is a series of syndrome commonly seen with advanced cirrhosis, which seriously affects patient's quality of life and survival. This study was designed to access the efficacy and safety of selective esophagogastric devascularization in the modified Sugiura procedure for patients with cirrhotic hemorrhagic portal hypertension. Methods Sixty patients with hepatitis B cirrhotic hemorrhagic portal hypertension and meeting the inclusion criteria were selected and randomly divided by using computer into the selective modified Sugiura group (sMSP group, n = 30) and the modified Sugiura group (MSP group, n = 30). The primary endpoint measurement is the postoperative rebleeding rate. Secondary endpoint measurements included free portal venous pressure, liver Child–Pugh score, liver volume, portal vein width and blood flow velocity, survival rate, quality of life, and dysphagia as well as other complications one year postoperatively. This trial is registered with ChiCTR, number ChiCTR2000033468. Results There was no statistically significant difference in rebleeding rates within one year after surgery between patients in the sMSP and MSP groups (χ = 0.11, p=0.73). In comparison with the MSP group, the Child–Pugh score of liver function in the sMSP group significantly increased (χ = 6.4, p=0.04) and the incidence of dysphagia was significantly reduced (χ = 6.23, p=0.01) one year after surgery. There was a statistically significant difference in the quality of life between the two groups. However, there were no statistically significant differences in free portal venous pressure (MD = −3.44, 95% CI: −7.87 to 0.98, p=0.12), postoperative liver volume (3 months: MD = -258.81, 95% CI: −723.21 to 205.57, p=0.24; 1 year: MD = −320.12, 95% CI: −438.43 to 102.78, p=0.16), postoperative portal vein width (3 months: MD = −0.06, p=0.50; 1 year: MD = 0.17, p=0.21), portal vein flow velocity (3 months: MD = 1.64, p=0.21; 1 year: MD = −1.19, p=0.57), 1-year survival rate (χ = 1.01, p=0.31), and other complications between the two groups. Conclusions Selective esophagogastric devascularization in the modified Sugiura procedure may not lower the incidence of rebleeding in the short term based on our findings. However, it may significantly improve quality of life of patients with cirrhotic hemorrhagic portal hypertension, improve liver function, and reduce postoperative dysphagia.
Highlights
Portal hypertension is a common clinical syndrome characterized by an increase in pressure gradient between the portal vein and the inferior vena cava
Upper gastrointestinal bleeding caused by varicose veins is a main course of death in patients with portal hypertension [2, 3]. e risk of Canadian Journal of Gastroenterology and Hepatology gastrointestinal bleeding in patients with severe varices is approximately 30% in 2 years [4], and the risk of rebleeding within 2 years increases to nearly 70% without prophylactic treatment [5]. e mortality rate of patients with esophagogastric variceal bleeding has reduced significantly in recent decades
Inclusion criteria were as follows: (1) patients with decompensated hepatic cirrhosis after hepatitis B, combined with splenomegaly, hypersplenism, and esophagogastric varices; (2) after the first or second esophageal and gastric variceal bleeding, and the bleeding was stopped by medical treatment for at least one week; (3) no history of endoscopic ligation or sclerotherapy prior to surgery, and no Transjugular intrahepatic portal systemic shunt (TIPS) or other devascularization treatment; (4) no thrombosis in the portal vein and its branches by preoperative abdominal computational tomography (CT) or ultrasound; (5) no liver cancer or other malignant tumors were found; (6) it was confirmed during the operation that esophageal veins did not directly enter the esophagus, and perforating veins clearly existed; and (7) adult patients who agreed to undergo the modified Sugiura procedure and sign informed consent
Summary
Portal hypertension is a common clinical syndrome characterized by an increase in pressure gradient between the portal vein and the inferior vena cava. Inclusion criteria were as follows: (1) patients with decompensated hepatic cirrhosis after hepatitis B, combined with splenomegaly, hypersplenism, and esophagogastric varices; (2) after the first or second esophageal and gastric variceal bleeding, and the bleeding was stopped by medical treatment for at least one week; (3) no history of endoscopic ligation or sclerotherapy prior to surgery, and no TIPS or other devascularization treatment; (4) no thrombosis in the portal vein and its branches by preoperative abdominal CT or ultrasound; (5) no liver cancer or other malignant tumors were found; (6) it was confirmed during the operation that esophageal veins did not directly enter the esophagus, and perforating veins clearly existed; and (7) adult patients who agreed to undergo the modified Sugiura procedure and sign informed consent. Random assignment was performed after it was determined that the patient’s esophageal vein did not directly enter the esophagus
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
