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Left-upper-quadrant devascularization for 'unshuntable' portal hypertension

M T Caps¹, W S Helton, K Johansen

¹Department of Surgery, University of Washington School of Medicine, Seattle, USA.

Archives of Surgery (Chicago, Ill. : 1960)

|August 1, 1996

Summary

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Left-upper-quadrant devascularization offers a safe and effective treatment for bleeding caused by unshuntable portal hypertension. This one-stage procedure avoids operative deaths and recurrent hemorrhage in most patients.

Area of Science:

Gastroenterology
Surgical Oncology
Hepatology

Background:

Diffuse splanchnic venous thrombosis causes "unshuntable" portal hypertension, a condition with limited treatment options.
Radical gastroesophageal devascularization or esophagogastrectomy were previously considered the only effective treatments for bleeding varices in these patients.

Purpose of the Study:

To evaluate the efficacy and safety of a one-stage, left-upper-quadrant devascularization procedure for managing unshuntable portal hypertension.

Main Methods:

A retrospective review of eight consecutive patients with recurrent variceal bleeding due to diffuse splanchnic venous thrombosis.
The surgical intervention included splenectomy, staple transection of the esophagus, and proximal gastric devascularization.

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Main Results:

No operative mortality was observed in the study cohort.
Seven of eight patients survived with a mean follow-up of 4.7 years, and none experienced recurrent variceal bleeding.
Complications were infrequent, with three early and one late complication reported.

Conclusions:

One-stage left-upper-quadrant devascularization is a safe, effective, and durable alternative for patients with unshuntable portal hypertension.
This approach provides a less invasive option compared to traditional radical esophagogastrectomy or the Sugiura procedure.