Paraesophagogastric Devascularization Research Articles

Improvement of human platelet aggregation post-splenectomy with paraesophagogastric devascularization in chronic hepatitis B patients with cirrhotic hypersplenism

Thrombocytopenia is a common hematological abnormality in patients with cirrhotic hypersplenism. Splenectomy with paraesophagogastric devascularization (SPD) is a conventional surgical therapy which can reverse pancytopenia in these patients. Platelets are traditionally recognized for their central role in hemostasis. However, the status of platelet aggregation in chronic hepatitis B patients with cirrhotic hypersplenism before and after SPD has not been reported yet. A total of 41 cirrhotic patients and 31 healthy controls were included in this study. Platelet aggregation was detected by AggRAM® Advanced Modular System (Helena Laboratories, USA). ELISA was used to detect the cytokines closely related to platelet aggregation. Expressions of platelet membrane glycoproteins (GPs) were evaluated by flow cytometric analysis. Platelet aggregation was found to be decreased distinctly in the cirrhotic patients, and to be restored to normal level after SPD. The cirrhotic patients showed higher plasma levels of the cytokines HMGB1, PEDF, vWF, cAMP and cGMP, which also improved partially after SPD. Moreover, the cirrhotic patients had much lower expression of GPIIb/IIIa, GPIbα and P-selectin than either the healthy controls or SPD patients at basal or activated level. Generally, SPD benefits cirrhotic patients with bleeding tendencies by improving platelet counts and aggregation. GPIIb/IIIa may be the key membrane protein responsible for the change in platelet aggregation before and after SPD.

Combined Rex-bypass shunt with pericardial devascularization alleviated prehepatic portal hypertension caused by cavernomatous transformation of portal vein

ABSTRACTObjective: To evaluate the effects of combined Rex-bypass shunt and pericardial devascularization on prehepatic portal hypertension secondary to cavernomatous transformation of portal vein (CTPV).Methods: Forty-two patients aged from 3 years to 49 years (divided into 3 groups), 26 cases male and 16 female, with prehepatic vascular hepertention were treated with Rex-bypass shunt combined with pericardial devascularization. In each patient, preoperative assessment included ultrasound and computed tomographic angiography of the portal vein and blood analysis. The procedure was Rex-bypass shunt (with or without graft), and patients with moderate or severe gastroesophageal varices required additional paraesophagogastric devascularization. Splenectomy or subtotal splenectomy was performed if combined hypersplenism co-existed. All data were analyzed retrospectively.Results: No intraoperative death occurred, blood routine analysis improved (P < 0.05), the blood flow velocity (P < 0.05) and diameter (P < 0.05) of the left portal vein (LPV) significantly increased, the esophageal and gastric varices significantly relieved in 34 patients (P < 0.05), and better effects of earlier operations were demonstrated than the delayed ones (P < 0.05). During the period of follow-up from 6 to 64 months, the overall patency rate was 85.7% and the younger the age the better of the effect.Conclusion: Rex-bypass shunt combined with pericardial devascularization is a safe and effective procedure for prehepatic portal hypertension caused by CTPV.

Long‐term Results of the Paraesophagogastric Devascularization with or without Esophageal Transection: Which Is More Suitable for Variceal Bleeding?

It has been reported that the paraesophagogastric devascularization with esophageal transection procedure, also known as the modified Sugiura procedure, was effective in the treatment of variceal bleeding. However, it was not widely accepted by other surgeons because of the high rate of rebleeding, complications, and mortality. To discover the effects of the paraesophagogastric devascularization procedure and the modified Sugiura procedure, we retrospectively analyzed the outcomes of these two procedures. During January 1990 and December 2009, 278 patients with variceal bleeding underwent devascularization after failed pharmacotherapy and endotherapy. In these 278 patients, 180 underwent paraesophagogastric devascularization without esophageal transection (group I), and the other 98 patients were subjected to the modified Sugiura procedure (group II). Postoperative mortality was 7.2% in group I, and 9.2% in group II (P = 0.563). The postoperative rebleeding rate in the two groups was 2.2 and 3.1%, respectively (P = 0.474). After a mean follow-up of 67.9 ± 37.3 months and 67.4 ± 44.6 months, respectively, esophageal transaction-related morbidity (leak, bleeding, and stricture) was 8.2% (8/98) in group II and 0% (0/180) in group I (P < 0.001). The overall rebleeding rate was 27% (41/152) in group I, and 27.2% (22/81) in group II (P = 0.976). The overall mortality was 28.3% (43/152) in group I, and 28.4% (23/81) in group II (P = 0.986). In the management of variceal bleeding, paraesophagogastric devascularization without esophageal transection is as effective and safe as devascularization with esophageal transaction, but with less esophageal transection-related morbidity.

Surgical treatment of primary liver cancer associated with portal hypertension

Objective To investigate the surgical treatment of primary liver cancer associated with por-tal hypertension(PHT). Methods The clinical data of 128 with primary liver cancer associated with PHT sur-gically treated in our hospital from October 1993 to October 2008 were retrospectively analyzed. Results They received hepatectomy ,hepatectomy + paraesophagogastric devaseula-rization, hepatectomy + splenectomy, hepa-teetomy + ligation of splenic artery ,hepatic carcinoma radiofrequency ablation + paraesophagogastric devascula-rization or splenectomy. Conclusion The exact therapeutic strategy should be used according to the concrete situations of primary liver cancer associated with PHT. Key words: Liver cancer; Portal hypertension; Surgical treatment

Effect of different portal-azygos devascularization procedures on apoptosis of gastric mucosal cells in portal hypertension canines with cirrhosis

Objective To detect apoptosis of gastric mucosal cells in portal hypertension canines with cirrhosis after different portal-azygos devascularization procedures and investigate their effects on portal hypertension gastropathy(PHG).Methods Portal hypertension was induced in canines by subcutaneous injection of 60% CCI4 emulsion and diet control.Twenty-four portal hypertension model canines were randomly divided 4 groups:group A(traditional paraesophagogastric devascularization group),group B (selective paraesophagogastric devascularization group),group C(selective paracsophagogastric devascularization plus distal esophageal transaction and reanastomosis with stapler group),and group D(control group,sham operation).The changes in free portal pressure(FPP)and apoptosis of gastric mucosa cells were observed during operation and 6 months after operation.Apeptosis index(AI)was measured by TUNEL.and the expression of Caspase-3 was detected by immunohistotehemistry.Results FPP in groups A.B and C were decreased significantly post-operation and at the 6th month post-operation as compared with pre-operation(P＜0.05).FPP in group A(2.05±0.07)kPa was significantly higher than that in groups B(1.28±0.05)kPa and C(1.41±0.04)kPa(P＜0.05),and that in group C hisher than in group B(P＜0.05).At the 6th month pest-operation,AI was increased significantly from(14.68±1.28)% to(20.22±2.20)% (P＜0.05),and the expression of Caspase-3 was also increased from 56.13±11.75 to 113.78±19.80(P＜0.05).In group B,AI was decreased from(13.63±1.19)% to (9.98±2.29)%(P＜0.05),and in group A the expression of Caspase-3 was decreased from 59.13±10.07 to 22.35±4.75(P＜0.05).In groups C and D,AI and the expression of Caspase-3 had no significant difference before and 6 six months post-operation(P＞0.05).Concision In portal hypertension canines with cirrhosis,the apoptosis of gastric mucosa cells is increased,and PHG aggravates after traditional paraesophagogastric devascularization.Selective paraesophagogastric devascularization can ameliorate the apoptosis of gastric mucosa cells and PHG.The apoptosis of gastric mucosa cells and PHG have no significant changes after selective paraesophagogastric devascularization plus distal esophageal transaction and reanastomosis with stapler. Key words: Portal hypertension; Devascularization; Stapler; Apoptosis; Canine

Laparoscopic splenectomy and pericardial devascularization for treatment of portal hypertension due to liver cirrhosis

To evaluate the safety and efficacy of laparoscopic splenectomy (LS) and pericardial devascularization in treatment of portal hypertension due to liver cirrhosis. Twenty three cases with hepatitis B and schistosoma cirrhosis and portal hypertension underwent LS and paraesophagogastric devascularization performed by one treatment team. Follow-up was conducted for 9 months. LS combined with pericardial devascularization was successfully performed on these 20 cases. Three cases were converted to open surgery due to intra-operative bleeding. The mean operative time was 235 min (180 - 350), and mean intra-operative blood loss was 520 ml (200 - 1600 ml). All patients were treated with plasma transfusion, antibiotics, and abdominal drainage post-operatively. Peristalsis of stomach and intestine recovered 24 - 72 hours after operation. The mean hospitalization time was 8.5 days (6 - 17 days). The peri-operative complication included plural effusion in 3 cases and subphrenic abscess in one case, .mild ascites in two cases, and wound dehiscence in one case. No mortality occurred. Rebleeding rare was 0%. LS combined with pericardial devascularization is relatively safe and effective in treatment of portal hypertension due to liver cirrhosis. The keys to success include experienced laparoscopic skills, use of harmonic scalpel and careful manipulation.

Sugiura procedure in the surgical treatment of bleeding esophageal varices in children: Long-term results

Recurrent bleeding, the high occurrence of encephalopathy, and the impairment of hepatic function in the successful cases of portasystemic shunts have led to increasing dissatisfaction with these procedures in recent years. Between March 1974 and November 1990 we have operated on 15 children for bleeding esophageal varices using the Sugiura procedure (esophageal transection with paraesophagogastric devascularization). In two cases the entire procedure was performed via the thoracic approach. The spleen was left in place in five cases. We have had no mortality. Operative complications included bleeding in the early postoperative period in two children and partial leakage from the esophageal suture in two others. Follow-up was from 4 years 3 months to 16 years 8 months with an average of 10 years 4 months. Long-term results have been gratifying in 12 patients (80%) with disappearance of the varices and no evidence of recurrent bleeding. Three children (20% of the patients) had recurrent bleeding 4 1 2 years, 4 years 2 months, and 2 1 2 years after the surgical procedure. In all cases there was no evidence of esophageal stenosis, gastroesophageal reflux, or hiatal hernia, nor signs of encephalopathy nor impairment of hepatic function. In our opinion the Sugiura procedure is a valid procedure in the surgical treatment of esophageal varices bleeding in the pediatric age with a high rate of success (80%) and without late complications.

SURGICAL TREATMENT OF ESOPHAGEAL VARICES

Between March, 1975, and March, 1988, 51 patients with esophageal varices due to portal hypertension were treated and thirty-eight of these underwent direct interruption surgery. One patient was carried out decompression surgery (distal splenorenal shunt).Twenty-two patients had liver cirrhosis, seventeen were diagnosed as idiopathic portal hypertension.We preferred the one-staged combined procedure of transabdominal transection using an autosuture apparatus, splenectomy and paraesophagogastric devascularization. The direct interruption procedure for the remaining patients were transthoracic esophageal transection, splenectomy with devascularization and others.The overall operative mortality rate within one month was 5/38 or 13%. Five-year survival rate in the 30 cases of transection surgery were 71%.Surgical therapy should be carried out as electively as possible, because of high mortality of emergency operation.

食道静脈りゅう治療における内視鏡的硬化療法と経胸食道離断術（杉浦法）の比較検討

食道静脈りゅう治療における内視鏡的硬化療法と経胸食道離断術（杉浦法）の比較検討

HEMORRHAGE FROM GASTRITIS IN THE EARLY STAGE AFTER ESOPHAGEAL TRANSECTION WITH DEVASCULARIZATION

Hemorrhage from gastritis occurring within the first month after direct procedure for esophageal varices was studied. Three of 473 cases (0.6%) bled from endoscopically diagnosed gastritis. All 3 cases underwent the one-stage combined procedure of transthoracic esophageal transection and transdiaphragmatic splenectomy and paraesophagogastric devascularization. However, they did not undergo pyloroplasty, as is our usual procedure with paragastric devascularization. Only 4 cases underwent a one-stage operation without pyloroplasty, and 3 of them (75%) had complicating hemorrhagic gastritis. A possible cause of the hemorrhagic gastritis is a combination of decreased gastric mucosal defense factors with changes in gastric mucosal blood flow due to wide paragastric devascularization and increased gastric mucosal attack factors with disturbance of gastric emptying due to vagotomy. It may be conculuded that these changes remain only a short time after operation, because recurrent bleeding has not occurred in the 3 cases.

Results of six hundred thirty-six esophageal transections with paraesophagogastric devascularization in the treatment of esophageal varices

This report describes 636 patients with portal hypertension in whom esophageal transections with paraesophagogastric devascularization were performed for the management of esophageal varices. The procedure was a prophylactic measure in 185 patients, elective surgery in 349, and an emergency procedure in 102. Portal hypertension was due to cirrhosis of the liver in 464 patients (40 alcoholic and 424 cryptogenic), idiopathic portal hypertension in 99, extrahepatic portal vein occlusion in 38, hepatoma in 22, and other causes in 13. The operative mortality rates were as follows: emergency 13.7%, elective cases 3.2%, prophylactic cases 4.3%, and overall 5.2%. There were no deaths in the 233 patients in Child's clinical class A; 232 class B patients had a 2% mortality rate, and 171 class C patients had a 17% mortality rate. The 10-year actuarial survival rates in patients with cirrhosis of the liver were 55% in emergency cases and 72% in both prophylactic and elective cases. In patients without cirrhosis the survival rates were 90%, 96%, and 95%, respectively. Recurrence of variceal bleeding or varices was less than 5%. We conclude that the Sugiura procedure is safe and effective in controlling esophageal varices and prolongs the long-term survival of patients with portal hypertension.

Results of six hundred thirty-six esophageal transections with paraesophagogastric devascularization in the treatment of esophageal varices

Results of six hundred thirty-six esophageal transections with paraesophagogastric devascularization in the treatment of esophageal varices

Paradoxic elevation of serum growth hormone levels after splenectomy and/or paraesophagogastric devascularization in patients with portal hypertension

Blood glucose, serum immunoreactive insulin (IRI), and serum growth hormone (GH) levels during 50-g oral glucose tolerance tests (OGTT) were determined before and after splenectomy with or without paraesophagogastric devascularization in patients with portal hypertension (13 liver cirrhosis and 8 idiopathic portal hypertension) and in 5 splenectomized patients with diseases other than portal hypertension. Before splenectomy with devascularization, only 1 of 15 patients with portal hypertension exhibited a paradoxic elevation of serum GH levels of more than 10 ng/ml above the fasting levels after glucose loads. After the operation, however, 10 of these 15 patients showed the paradoxic elevation. Frequency of the paradoxic elevation was significantly higher after the operation than before ( p < 0.001). The abnormal response of serum GH levels to glucose loads did not correlate with any of the blood glucose concentrations, serum IRI levels, and values for liver function tests. The paradoxic elevation was also observed in 4 of 6 patients with portal hypertension who underwent splenectomy alone without devascularization. These 4 patients with paradoxic elevation were splenectomized 4 wk and 2 1 2 , 20, and 29 yr previously. However, none of 5 splenectomized patients without portal hypertension showed the paradoxic elevation. The reason why the paradoxic elevation was observed after splenectomy only in patients with portal hypertension but not in patients without portal hypertension may be sought for in the changes of portal venous flow rather than splenectomy itself.

Emergency esophageal transection with paraesophagogastric devascularization for variceal bleeding

AbstractSince 1967, a total of 52 patients with portal hypertension have undergone emergency esophageal transection with paraesophagogastric devascularization in 2 stages, 4–6 weeks apart, to control variceal bleeding. According to the Child classification, 8 patients were class A, 19 were class B, and 25 were class C. The etiology of the portal hypertension was cirrhosis of the liver in 30 patients, liver fibrosis in 13, extrahepatic portal vein occlusion in 4, hepatoma in 4, and carcinoma of the pancreas in 1 patient. There were 6 operative deaths (11.5%), caused by progressive hepatic failure (2), hepatoma (2), renal failure (1), and intraperitoneal bleeding (1). The operative mortality rate in the class A and B patients was 0%, but in the class C patients, it was 24%. The operative mortality rate for cirrhotic patients was 10%. There have been 9 late deaths due to hepatic failure (2), hepatoma (4), esophageal variceal bleeding (2), and carcinoma of the pancreas (1). At present, 88% of class B patients are alive, but only 56% of class C patients are alive. There was an obvious positive correlation between survival rate and the stage of the disease. Only 2 patients with incomplete devascularization developed recurrent esophageal variceal bleeding and died (recurrence rate of 4.3%). All survivors are free of hepatic encephalopathy.This method provided excellent results in controlling variceal bleeding without causing hepatic dysfunction and encephalopathy and is indicated in all patients with variceal bleeding except those with severe hepatic failure.

Further evaluation of the Sugiura procedure in the treatment of esophageal varices.

• A total of 276 patients had an esophageal transection with paraesophagogastric devascularization (the Sugiura procedure) for esophageal varices from 1967 to the present; 60 procedures were prophylactic, 164 were elective, and 52 were emergency procedures. The age distribution was from 9 months to 74 years. The origin was cirrhosis in 191 patients, fibrosis in 59, extrahepatic portal vein occlusion in 18, hepatoma in five, schistosomiasis in one, Budd-Chiari syndrome in one, and carcinoma of the pancreas in one patient. The mortality within one month of operation was 5.0% in prophylactic cases, 1.8% in elective cases, and 11.5% in emergency cases (mean, 4.3%). The actuarial seven-year survival rate was 83%. There was an obvious positive correlation between survival rate and stage of the disease. Ninety-five percent of class A (Child's classification) and 87% of class B are alive, but only 59% of class C patients are alive at the present. Six patients had recurrences of varices for a recurrence rate of 2.3%, of whom four had esophageal bleeding. It may be that recurrence of varices occurred due to incomplete devascularization of the esophagus at the diaphragm because of the necessity of two-stage operations in poor-risk patients. All survivors are free from encephalopathy. The present study reconfirmed that our method is safe and effective in controlling esophageal variceal bleeding without compromising hepatic function. ( Arch Surg 112:1317-1321, 1977)

Esophageal transection with paraesophagogastric devascularization: surgical treatment of esophageal varices

Ninety-eight patients who have undergone transthoracic esophageal transection with paraesophagogastric devascularization are reviewed. Ages ranged from 9 months to 74 years. Over-all operative mortality was 5.1%. Postoperative hemorrhage occurred in 2 patients, a patient with hepatoma and another with incomplete devascularization of the esophagus at the diaphragm. Disappearance of the esophageal varices was seen in 91 (98%) of all 93 survivors.

Plasma insulin responses to glucose in femoral, hepatic, and pancreatic veins in dogs.

ARTICLESPlasma insulin responses to glucose in femoral, hepatic, and pancreatic veins in dogsY Kanazawa, T Kuzuya, T Ide, and K KosakaY Kanazawa, T Kuzuya, T Ide, and K KosakaPublished Online:01 Aug 1966https://doi.org/10.1152/ajplegacy.1966.211.2.442MoreSectionsPDF (1 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByVariability of Directly Measured First-Pass Hepatic Insulin Extraction and Its Association With Insulin Sensitivity and Plasma Insulin11 May 2018 | Diabetes, Vol. 67, No. 8Both positive and negative portal venous and hepatic arterial glucose gradients stimulate hepatic glucose uptake after the same amount of glucose is infused into the splanchnic bed in conscious dogsMetabolism, Vol. 47, No. 11Impaired biphasic insulin release in mildly diabetic rats bearing a chronic portal vein catheterPhysiology & Behavior, Vol. 50, No. 4Disopyramide induces insulin secretion and plasma glucose diminution: Studies using the in situ canine pancreasMetabolism, Vol. 38, No. 2Effects of portacaval shunt, transposition, and dimethylnitrosamine-induced chronic liver injury on pancreatic hormones and amino acids in dogJournal of Surgical Research, Vol. 46, No. 1A mathematical model for insulin kinetics and its application to protein-deficient (malnutrition-related) diabetes mellitus (PDDM)Journal of Theoretical Biology, Vol. 126, No. 4Non-obese-diabetic mice: immune mechanisms of pancreatic ?-cell destructionDiabetologia, Vol. 27, No. S1paracrine regulation of islet B-cell function by A and D cellsLife Sciences, Vol. 32, No. 16Insulin Injected into CNS Structures or into the Carotid Artery: Effect on Carbohydrate Homeostasis of the Intact AnimalFunction of pancreatic endocrine cells in experimental acute pancreatitisWorld Journal of Surgery, Vol. 6, No. 4Dynamics of insulin and glucagon secretion by the isolated perfused cat pancreasComparative Biochemistry and Physiology Part A: Physiology, Vol. 72, No. 2Insulin-Sensitive Glucoregulator Chemoreceptors in the Central Nervous System: Their Putative Role in Glucose HomeostasisHepatic metabolism of glucagon in the dog: contribution of the liver to overall metabolic disposal of glucagonJ. B. Jaspan, K. S. Polonsky, M. Lewis, J. Pensler, W. Pugh, A. R. Moossa, and A. H. Rubenstein1 March 1981 | American Journal of Physiology-Endocrinology and Metabolism, Vol. 240, No. 3Paradoxic elevation of serum growth hormone levels after splenectomy and/or paraesophagogastric devascularization in patients with portal hypertensionMetabolism, Vol. 29, No. 6Effect of spontaneous portal-systemic shunting on plasma insulin and amino acid concentrationsGastroenterology, Vol. 78, No. 4Increase in insulin response after treatment of overt maturity-onset diabetes is independent of the mode of treatmentDiabetologia, Vol. 18, No. 1Insulin and glucagon concentrations in portal and peripheral veins in patients with hepatic cirrhosisDiabetologia, Vol. 17, No. 1Evaluation of insulin secretory capacity in diabetes mellitusHuman Pathology, Vol. 10, No. 3Human C-peptide immunoreactivity (CPR) in blood and urine ? Evaluation of a radioimmunoassay method and its clinical applicationsDiabetologia, Vol. 12, No. 5Disappearance rate of endogenous human C-peptide from bloodDiabetologia, Vol. 12, No. 5Plasma insulin concentration in the femoral, hepatic, and pancreatico-duodenal veins in dogs during standard and cortisone glucose tolerance testsBulletin of Experimental Biology and Medicine, Vol. 81, No. 6Defective early phase insulin release in perifused isolated pancreatic islets of spiny mice (acomys cahirinus)Diabetologia, Vol. 11, No. 5The Kinetics of Insulin ReleaseInsulin secretory response of diabetics during the period of improvement of glucose tolerance to normal rangeDiabetologia, Vol. 10, No. 6Glucose-induced insulin release patterns: Effect of starvationDiabetologia, Vol. 10, No. 5Profil der Glucosestimulierten Insulinsekretion im Pfortaderblut des MenschenKlinische Wochenschrift, Vol. 52, No. 12Impairments in availability of insulin to liver in vivo and in binding of insulin to purified hepatic plasma membrane during agingBiochemical and Biophysical Research Communications, Vol. 54, No. 4Abnormal insulin secretion in amyotrophic lateral sclerosisJournal of the Neurological Sciences, Vol. 16, No. 2Electrical responses of pancreatic islet cells to secretory stimuliBiochemical and Biophysical Research Communications, Vol. 46, No. 4IN VITRO STUDIES SUGGESTING A TWO-COMPARTMENTAL MODEL FOR INSULIN SECRETIONA Two-Compartmental Model for Insulin SecretionINTRAVENOUS GLUCOSE TOLERANCE, PLASMA INSULIN, FREE FATTY ACIDS AND β-HYDROXYBUTYRATE IN UNDERWEIGHT NEWBORN INFANTSActa Paediatrica, Vol. 58, No. 5Studies on the mechanism of xylitol-induced insulin secretion in dogsDiabetologia, Vol. 5, No. 4Mathematical models of the kinetics of glucose and insulin in plasmaThe Bulletin of Mathematical Biophysics, Vol. 31, No. 1Stimulation of Insulin Secretion by Xylitol AdministrationPlasma insulin response to intravenously administered xylitol in dogsMetabolism, Vol. 15, No. 12 More from this issue > Volume 211Issue 2August 1966Pages 442-448 Copyright & PermissionsCopyright © 1966 by American Physiological Societyhttps://doi.org/10.1152/ajplegacy.1966.211.2.442PubMed5921106History Published online 1 August 1966 Published in print 1 August 1966 Metrics