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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
[Application effect of pericardial devascularization plus gastric fundus transaction in advanced schistosomiasis]
Li Xiang-Wen1, Luo Jian-Fang1, Song Jin-Wen1
1Third people's Hospital of Yangxin County, Hubei Province, Yangxin 435200, China.
Insights
Pericardial devascularization plus gastric fundus transaction offers a simpler, effective short-term treatment for advanced schistosomiasis patients with portal hypertension, proving suitable for primary hospitals.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatology
Background:
- Portal hypertension is a serious complication of advanced schistosomiasis.
- Effective surgical interventions are crucial for managing portal hypertension and its sequelae.
- Traditional surgical methods may involve complex procedures and longer recovery times.
Purpose of the Study:
- To evaluate the clinical efficacy of pericardial devascularization plus gastric fundus transaction in patients with advanced schistosomiasis and portal hypertension.
- To compare this technique with the modified Sugiura operation.
Main Methods:
- A comparative study involving 36 patients undergoing pericardial devascularization plus gastric fundus transaction (portal hypertension group) and 10 patients undergoing modified Sugiura operation (modified Sugiura operation group).
- Key outcomes measured included operation time, postoperative recovery parameters, hospitalization costs, and complication rates.
Main Results:
- The portal hypertension group demonstrated significantly shorter operation times, reduced indwelling stomach tube duration, earlier oral feeding, and quicker drainage tube removal (P<0.05).
- Hospitalization expenses were significantly lower in the portal hypertension group (P<0.05).
- While portal thrombosis and rehemorrhage rates showed no statistical difference between groups, the modified Sugiura operation group experienced delayed gastric emptying and esophageal stomal leak, which were absent in the portal hypertension group.
Conclusions:
- Pericardial devascularization plus gastric fundus transaction is a relatively simple procedure with good short-term clinical outcomes.
- This technique is suitable for implementation in primary healthcare settings.
- Further long-term follow-up is necessary to fully ascertain the durability of its effects.
Objective:
To discuss the effect of pericardial devascularization plus gastric fundus transaction in advance schistosomiasis patients with portal hypertension.
Methods:
Thirty-six advanced schistosomiasis patients with portal hypertension treated with devascularization plus gastric fundus transaction (a portal hypertension group), as well as 10 patients treated with modified Sugiura operation (a modified Sugiura operation group) in the Third People's Hospital of Yangxin County since 2006 were chosen as the observation objects, and the clinical effects of the two groups were observed and compared.
Results:
The operation time, indwelling time of stomach tube, time to taking food after operation, drainage tube removal time of the portal hypertension group were all shorten than those of the modified Sugiura operation group (all P＜0.05). The hospitalization expenses of the two groups were (25 466.00 ± 2 888.48) Yuan and (34 517.10 ± 4 948.39) Yuan respectively, and the difference was also statistically significant (P＜0.05). The incidence rates of portal thrombosis of the portal hypertension group and modified Sugiura operation group were 33.33% (12/36) and 40.00% (4/10), respectively, and the incidence rates of rehaemorrhagia of the two groups 12 months after the operation were 16.67% (6/36) and 10.00% (1/10), respectively, but the differences had no statistically significance (both P ＞ 0.05). In addition, 1 case with delayed gastric emptying and 1 case with stomal leak of esophagus happened in the modified Sugiura operation group, while no corresponding complications happened in the portal hypertension group.
Conclusions:
Pericardial devascularization plus gastric fundus is a relatively easy procedure which has a good short-term clinical effect, and therefore it is suitable for application in primary hospitals. However, its long-term effect still needs further observation.
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