Selective periesophagogastric devascularization in portal hypertension: results of 56 patients

Area of Science:

• Hepatology and Gastroenterology
• Surgical Interventions for Portal Hypertension

Background:

• Esophageal varices are a serious complication of portal hypertension, often leading to life-threatening bleeding.
• Traditional surgical treatments for variceal bleeding have varying success rates and complication profiles.
• Selective Periesophogastric Devascularization (SPD) is a modified surgical approach designed to improve outcomes.

Purpose of the Study:

• To evaluate the effectiveness and safety of the novel Selective Periesophogastric Devascularization (SPD) procedure.
• To assess SPD's impact on controlling acute variceal bleeding and preventing recurrence.
• To analyze postoperative morbidity, mortality, and long-term survival rates following SPD.

Main Methods:

• Retrospective review of 56 patients who underwent SPD for bleeding esophageal varices.
• Patients had various etiologies of portal hypertension, primarily chronic HBV cirrhosis (80.4%).
• Evaluation included acute bleeding control, morbidity, mortality, variceal eradication, recurrence, encephalopathy, and 3-year survival.

Main Results:

• Hemorrhage was controlled in all patients with zero mortality.
• Complete variceal eradication was achieved in 87.5% of patients; recurrent bleeding occurred in 8.9%.
• Three-year survival rates varied by Child-Pugh grade: 100% for A, 71.4% for B, and 33% for C.

Conclusions:

• Selective Periesophogastric Devascularization (SPD) is a safe and effective surgical option for managing bleeding esophageal varices.
• The procedure demonstrates high rates of hemorrhage control and variceal eradication.
• SPD offers promising long-term survival outcomes, particularly in patients with less severe liver dysfunction (Child-Pugh A).