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

Abstract

Background: No simple solution exists for the patient with bleeding due to diffuse splanchnic venous thrombosis (so-called unshuntable portal hypertension). Radical gastroesophageal devascularization or extended esophagogastrectomy has been considered obligatory in this setting.

Objective: To examine the use of 1-stage, left-upper-quadrant devascularization for unshuntable portal hypertension.

Design: A retrospective call-back survey.

Setting: A regional referral center.

Patients: Eight consecutive patients with recurrent bleeding from esophagogastric varices due to diffuse splanchnic venous thrombosis.

Interventions: Splenectomy, staple transection of the esophagus, and proximal gastric devascularization.

Main outcome measures: Operative complications, recurrent bleeding, survival, and quality of life.

Results: No operative deaths occurred, and 7 of 8 patients who were treated for unshuntable portal hypertension and who were followed-up for 1 to 15 years (mean, 4.7 years) are alive. No patient has had a recurrent variceal hemorrhage. A second endoscopy has demonstrated small varices in 4 patients. Early and late complications occurred in 3 and 1 of the patients, respectively.

Conclusions: Left-upper-quadrant devascularization is a technically straightforward, safe, effective, and durable alternative to the Sugiura procedure or to radical esophagogastrectomy in patients with unshuntable portal hypertension.