Laparoscopic Distal Splenorenal Anastomosis

Dzidzava II1*, Kotiv BN1 , Onnicev IE1 , Soldatov SA1 , Smorodskiy AV1 , Shevcov SV1 , Bugaev SA1,2 and Apollonov AA1

1 Department of Hospital Surgery - Head of the Hospital Surgery Clinic, Military Medical Academy named after S.M. Kirova, St. Petersburg, Russia 2 A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russia

^*Correspondance to: Dzidzava II 

 PDF  Full Text DOI: 10.25107/2474-1647.3157

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% to 50% of survivors. Portosystemic shunt surgery provides for radical decompression of the portal vein system and reliably prevents 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 to 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 variation 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.

Keywords

Portal hypertension; Bleeding from varicose veins of the esophagus; Portocaval shunt; Distal splenorenal anastomosis

Cite the article

Dzidzava II, Kotiv BN, Onnicev IE, Soldatov SA, Smorodskiy AV, Shevcov SV, et al. Laparoscopic Distal Splenorenal Anastomosis. Clin Surg. 2021; 6: 3157.