Brief Article
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World J Gastroenterol. Dec 28, 2013; 19(48): 9418-9424
Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9418
Two surgical procedures for esophagogastric variceal bleeding in patients with portal hypertension
Lin Yang, Li-Juan Yuan, Rui Dong, Ji-Kai Yin, Qing Wang, Tao Li, Jiang-Bin Li, Xi-Lin Du, Jian-Guo Lu
Lin Yang, Li-Juan Yuan, Rui Dong, Ji-Kai Yin, Qing Wang, Tao Li, Jiang-Bin Li, Xi-Lin Du, Jian-Guo Lu, Department of General Surgery, Tangdu Hospital of the Fourth Military Medical University, Xi’an 710038, Shannxi Province, China
Author contributions: Yang L, Yuan LJ and Dong R contributed equally to this work; Yang L collected and analyzed the data, and drafted the manuscript; Yuan LJ designed and supervised the study; Dong R and Yin JK revised the manuscript for important intellectual content; Wang Q, Li T and Li JB offered the technical or material support; Du XL and Lu JG provided funding and administrative support; all authors have read and approved the final version to be published.
Correspondence to: Jian-Guo Lu, PhD, Department of General Surgery, Tangdu Hospital of the Fourth Military Medical University, No. 1 Xinsi Road, Xi’an 710038, Shaanxi Province, China. lujguo@fmmu.edu.cn
Telephone: +86-29-84777431 Fax: +86-29-84777431
Received: August 16, 2013
Revised: October 16, 2013
Accepted: November 1, 2013
Published online: December 28, 2013
Processing time: 151 Days and 4.8 Hours
Abstract

AIM: To determine the clinical value of a splenorenal shunt plus pericardial devascularization (PCVD) in portal hypertension (PHT) patients with variceal bleeding.

METHODS: From January 2008 to November 2012, 290 patients with cirrhotic portal hypertension were treated surgically in our department for the prevention of gastroesophageal variceal bleeding: 207 patients received a routine PCVD procedure (PCVD group), and 83 patients received a PCVD plus a splenorenal shunt procedure (combined group). Changes in hemodynamic parameters, rebleeding, encephalopathy, portal vein thrombosis, and mortality were analyzed.

RESULTS: The free portal pressure decreased to 21.43 ± 4.35 mmHg in the combined group compared with 24.61 ± 5.42 mmHg in the PCVD group (P < 0.05). The changes in hemodynamic parameters were more significant in the combined group (P < 0.05). The long-term rebleeding rate was 7.22% in the combined group, which was lower than that in the PCVD group (14.93%), (P < 0.05).

CONCLUSION: Devascularization plus splenorenal shunt is an effective and safe strategy to control esophagogastric variceal bleeding in PHT. It should be recommended as a first-line treatment for preventing bleeding in PHT patients when surgical interventions are considered.

Keywords: Comparative study; Portal hypertension; Splenorenal shunt; Devascularization; Esophagogastric variceal bleeding

Core tip: A comparison of two surgical techniques for esophagogastric variceal bleeding in patients with cirrhotic portal hypertension was performed. Pericardial devascularization and shunt are the main surgical strategies for the prevention of esophagogastric variceal bleeding in patients with portal hypertension (PHT). In this study, we found that devascularization plus splenorenal shunt was an effective and safe strategy for controlling esophagogastric variceal bleeding in PHT patients. This surgical technique should be recommended as a first-line treatment for the prevention of bleeding in PHT patients when surgical interventions are considered.