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Laparoscopic azygoportal disconnection procedure with a bipolar feedback controlled sealing system in a porcine model
A Shamiyeh1, R Hubmann, L Benkö
1Ludwig Boltzmann Research Institute for Operative Laparoscopy and 2nd Surgical Department, Academic Teaching Hospital, Linz, Austria. andreas.Shamiyeh@aon.at
Background:
To examine the feasibility of a new, minimally invasive procedure for the devascularization of the proximal stomach and distal esophagus to prevent recurrent variceal bleeding in portal hypertension in a new animal model.
Material And Methods:
Portal hypertension was created by laparoscopic clip ligation of the portal vein on 20 pigs. After 2 weeks the azygoportal disconnection procedure was performed with the LigaSure-ATLAS instrument.
Results:
There were 16 pigs out of 20 that survived both operations. Two died during introduction of anesthesia, one because of a cardiac arrest (second operation). One pig died resulting from necrosis of the gastric and esophageal wall. Autopsy (2 weeks later) showed that there was a complete arterial devascularization. At autopsy, none of the remaining 16 pigs had esophageal varices or necrosis of the stomach or esophagus.
Conclusion:
Laparoscopic azygoportal disconnection is a less invasive method for the prevention of rebleeding and seems to be safely performed with the LigaSure-ATLAS instrument.
