Correction of complications portal hypertension syndrome

Abstract

The results a new approach of simultaneous correction of complications of portal hypertension with endovideosurgical method are considered. Surgeries of 4 patients, suffering from portal hypertension, were performed by laparoscopic access and included gastric devascularization with ligation and the transection of the left gastric and short gastric veins; ligation of the splenic artery; resection of the parietal peritoneum, retroperitoneal tissue, and lumbar muscles in the lumbar triangle. Average duration of one surgery was 120±22 minutes. The highest volume of blood loss was 150±35 ml. There were no intraoperative complications. The average time spent in the IC unit was 14±4,2 hours. On the day following the surgery, all patients were able to get out of the bed, walked on their own and were allowed to have liquid food. Each patient had one session of endoscopic ligation with an overlay of 5 to 8 Cook ligatures to eradicate varicose veins of the esophagus. The postoperative period of hospital treatment was 10±2,3 days, treatment responses were favorable in all patients. The total time of inpatient stay was 22±3 days. All patients underwent two sessions of reinfusion of externally modified ascitic fluid. The postoperative spiral computer tomographies and subtraction digital angiographies showed effectiveness of disconnection of vessels in the gastroesophageal system. Blood flow in the splenic artery is not detected, ultrasound shows shrinkage of spleen. The maximum follow-up after the operation was 10 months. There were no episodes of bleeding recurrence and no signs of ascites. All patients are socially adapted and able to work, and do not present any complaints during follow-up examinations.