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Published in:

01-01-2018

Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy

Authors: Hirofumi Kawanaka, Tomohiko Akahoshi, Yoshihiro Nagao, Nao Kinjo, Daisuke Yoshida, Yoshihiro Matsumoto, Norifumi Harimoto, Shinji Itoh, Tomoharu Yoshizumi, Yoshihiko Maehara

Published in: Surgical Endoscopy | Issue 1/2018

Abstract

Background

Laparoscopic gastric devascularization(Lap GDS) and splenectomy (SPL) for gastric varices is technically challenging because of highly developed collateral vessels and bleeding tendency. We investigated the feasibility of customization of Lap GDS and SPL based on CT vascular anatomy.

Methods

We analyzed 61 cirrhotic patients with gastric varices who underwent Lap GDS and SPL between 2006 and 2014. Lap GDS was customized according to the afferent feeding veins (left gastric vein (LGV) and/or posterior gastric vein (PGV)/short gastric vein (SGV)) and efferent drainage veins (gastrorenal shunt and/or gastrophrenic shunt, or numerous retroperitoneal veins) based on CT imaging.

Results

Thirty-four patients with efferent drainage veins suitable for balloon-occluded retrograde transvenous obliteration (B-RTO) underwent B-RTO instead of surgical GDS, with subsequent Lap SPL. Among 27 patients with gastric varices unsuitable for B-RTO, 15 patients with PGV/SGV underwent Lap GDS of the greater curvature and SPL, and 12 patients with LGV or LGV/PGV/SGV underwent Lap GDS of the greater and lesser curvature and SPL. The mean operation time was 294 min and mean blood loss was 198 g. There was no mortality or severe morbidity. Gastric varices were eradicated in all 61 patients, with no bleeding or recurrence during a mean follow-up of 55.9 months. The cumulative 3-, 5-, and 7-year survival rates were 92, 82, and 64%, respectively.

Conclusions

Lap GDS and SPL customized based on CT vascular anatomy is a safe and effective procedure for treating gastric varices.

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Title: Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy
Authors: Hirofumi Kawanaka
Tomohiko Akahoshi
Yoshihiro Nagao
Nao Kinjo
Daisuke Yoshida
Yoshihiro Matsumoto
Norifumi Harimoto
Shinji Itoh
Tomoharu Yoshizumi
Yoshihiko Maehara
Publication date: 01-01-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 1/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5646-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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