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[Changes in portal circulation after esophageal transection]

D Zadrozny1, W Gacyk, T Draczkowski

  • 1I Katedry i Kliniki Chirurgii Akademii Medycznej w Gdańsku.

Wiadomosci Lekarskie (Warsaw, Poland : 1960)
|January 1, 1997
PubMed
Summary

The Hirashima procedure for hepatic cirrhosis and esophageal varices does not significantly alter portal blood flow or velocity. This surgical intervention demonstrates stable hemodynamic effects over long-term follow-up.

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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.

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  • 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.