[Changes in portal circulation after esophageal transection]

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Vascular Surgery

Background:

• Hepatic cirrhosis commonly leads to esophageal varices, a serious complication.
• The modified Sugiura (Hirashima) procedure is employed to manage these varices.
• Understanding the hemodynamic impact of this surgery is crucial for patient management.

Purpose of the Study:

• To evaluate the effect of the modified Sugiura (Hirashima) procedure on portal hemodynamics.
• To assess portal blood velocity (PBV) and portal blood flow (PBF) before and after surgery.
• To determine the long-term hemodynamic stability of the procedure.

Main Methods:

• Prospective study involving 104 patients with hepatic cirrhosis and esophageal varices.
• Portal hemodynamics (PBV and PBF) measured using Doppler ultrasonography.
• Measurements taken pre-operation, 2 weeks, 3 months, and at 6-month intervals post-operation, with long-term follow-up (18 months to 7 years).
• Comparison with a control group of 20 healthy volunteers.

Main Results:

• No significant decrease in mean PBV or PBF was observed post-surgery.
• Mean PBV decreased from 17.5 cm/s pre-op to 14.2 cm/s at 2 weeks and 15.1 cm/s at 3 months.
• Mean PBF decreased from 1211 ccm/min pre-op to 987 ccm/min at 2 weeks and 1179 ccm/min at 3 months.
• Late postoperative PBV was 14.0 cm/s and PBF was 1077 ccm/min.
• Portal vein thrombosis occurred in 4 cases pre-op and 7 new cases post-op, with recanalization in 3.

Conclusions:

• Extended gastroesophageal devascularization, splenectomy, and esophageal transection (Hirashima procedure) do not significantly reduce portal blood velocity and flow.
• The hemodynamic effects of the Hirashima procedure are stable throughout the observed follow-up period of 1.5 to 7 years.