scholarly journals First Clinical Experience of Venous Reconstruction With Autologous Vascular Prosthesis From the Sickle Ligament of the Liver With Partial Portosystemic Bypass Surgery

2021 ◽  
Vol 10 (3) ◽  
pp. 589-597
Author(s):  
A. Yu. Anisimov ◽  
A. A. Anisimov ◽  
A. I. Andreev ◽  
R. A. Ibragimov ◽  
A. T. Garaev
Keyword(s):  
Portal Hypertension ◽  
Clinical Experience ◽  
Bypass Surgery ◽  
Varicose Veins ◽  
Falciform Ligament ◽  
Viral Etiology ◽  
Gastric Bleeding ◽  
Vascular Prostheses ◽  
Venous Reconstruction

Aim of study. Presentation of our own first clinical experience of venous reconstruction in portosystemic bypass surgery with the use of autologous vascular prostheses of the falciform ligament of the liver in the splenorenal position in a patient with portal hypertension syndrome in the outcome of liver cirrhosis of viral etiology.Material and methods. Clinical observation of a patient born in 1978 with a diagnosis of cirrhosis of the liver of viral etiology (HCV) Child-Pugh A (6). MELD 10 points. Inactive phase. Intrahepatic portal hypertension syndrome. Esophageal varices grade III according to A. G. Scherzinger, gastric varices type I (GOV1) according to Sarin. Condition after repeated recurrent esophageal-gastric bleeding. Due to the high risk of another bleeding, as a secondary prevention of esophageal-gastric bleeding, partial splenorenal anastomosis of “H” - type was performed with the use of an autologous vascular prosthesis of the falciform ligament of the liver in the splenorenal position.Results. A flap measuring 60.0x20.0 mm was cut from the falciform ligament of the patient’s liver. From the latter, after adjusting the size of the graft to the individual needs of the patient, an autologous conduit was formed. It was used as an insert in the formation of an “H” - type splenorenal anastomosis with the imposition of two end-to-side anastomoses between the splenic vein and one end of the conduit and between the left renal vein and the other end of the conduit. The patency of the anastomosis was checked using intraoperative sonography. In a satisfactory condition, the patient was discharged for outpatient follow-up treatment at the place of residence. At the moment of writing the article, the follow-up period was 8 months. The bleeding did not recur. No varicose veins were found in the esophagus and stomach during control endoscopic examinations. The patency of the splenorenal shunt was confirmed by ultrasound dopplerography.Conclusion. The first clinical experience of venous reconstruction with portosystemic bypass surgery using as a possible replacement of autologous vascular prostheses of the falciform ligament of the liver in the splenorenal position in a patient with portal hypertension syndrome in the outcome of cirrhosis of the liver of viral etiology gives hope for the possibility of further successful testing of this method of splenorenal bypass surgery to reduce the risk of bleeding from varicose veins.

Falciform ligament appendagitis after Roux-en-Y bypass surgery mimicking acute cholecystitis

2020 ◽  
Vol 13 (8) ◽  
pp. e235642
Author(s):  
Lee K Rousslang ◽  
McHuy F McCoy ◽  
C Frank Gould
Keyword(s):  
Severe Pain ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Falciform Ligament ◽  
Rare Type ◽  
Epiploic Appendagitis ◽  
Radiological Features ◽  
Follow Up Studies ◽  
Focal Fat

Fatty falciform ligament appendage torsion (F-FLAT) is a rare type of intraperitoneal focal fat infarction that involves torsion of a fatty appendage of the falciform ligament. It may cause severe pain, mimicking an acute abdomen, but is typically self-limited and does not require hospitalisation or surgery. As a type of intraperitoneal focal fat infarction, it shares many of the same physiological, clinical and radiological features of epiploic appendagitis. To our knowledge, F-FLAT has not previously been reported in a patient following a laparoscopic Roux-en-Y gastric bypass surgery. Identifying falciform ligament appendagitis is critical because it can prevent unnecessary hospitalisation, follow-up studies and surgery.

scholarly journals Minimally invasive surgical interventions in the treatment and prevention of bleeding from varicose veins of the esophagus and stomach

2020 ◽  
Vol 39 (3) ◽  
pp. 65-73
Author(s):  
Bogdan N. Kotiv ◽  
Ilya I. Dzidzava ◽  
Sergey A. Alentyev ◽  
Petr N. Zubarev ◽  
Igor E. Onnicev ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Varicose Veins ◽  
Clinical Situation ◽  
Cirrhosis Of The Liver ◽  
Recurrent Bleeding ◽  
Gastric Bleeding ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Treatment And Prevention ◽  
Minimally Invasive Surgical

Treatment and prevention of complications of portal hypertension today is a complex and unsolved problem of hepatosurgery. Mortality from esophageal-gastric bleeding (ESH) of portal genesis ranges from 22 to 100%. The aim of the study is to improve the results of the treatment and prevention of digestive haemorrhage in portal hypertension by optimize using of miniinvasive interventions. A retrospective analysis of the treatment results of 128 patients with cirrhosis of the liver, in which the predominant complication of portal hypertension resulted in bleeding from varicose veins of the esophagus and the stomach, and a high risk of its occurrence or recidivism have been carried out. Gastric laparoscopic devascularization with endoscopic ligation reduces the lethality from esophageal-gastric bleeding, compared to only ligation, for six months after the operation by 21.8% (2 = 2.61; p = 0.106), 25.5% within a year (2 = 2.75; p = 0.091), for two years after the 25.4% operation (2 = 1.47; p = 0.225), for three years 25.5% (2 = 0.43; p = 0.051). There is a statistically reliable lack of differences in the groups of patients after the traditional and endovideoxyric operations of the portocal bypass in terms of the reduction of the degree of VDEV (84.3 and 86.7%), which indicates the equivalent effect of the performed operations. A comparative study of selective portocaval anastomoses and TIPS found no reliable difference in the frequency of recurrent bleeding. Post-shunt encephalopathy, thrombosis, and stenosis of the shunt were more common in the transjugular intrahepatic portosistame shunt (p 0.001), and survival in the group of surgical anastomosis was superior to that of TIPS. The above data indicate that the use of endoscopic, endovascular, endovision and endovision surgery, extracorporeal miniinvasive techniques is an integral part of the complex surgical treatment of patients with portal hypertension. Miniinvasive surgical treatments are required depending on the current clinical situation and the degree of liver-cell failure. Flexible and selective tactics make it possible to improve the results of treatment of patients with cirrhosis of the liver, complicated by portal hypertension (6 figs, bibliography: 14 refs).

scholarly journals Laparoscopic Distal Splenorenal Anastomosis

2021 ◽  
Vol 8 (3) ◽  
Author(s):  
Dzidzava II ◽  
◽  
Kotiv BN ◽  
Onnicev IE ◽  
Soldatov SA ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Minimally Invasive ◽  
Varicose Veins ◽  
Laparoscopic Approach ◽  
Surgical Decompression ◽  
Portal System ◽  
Shunt Thrombosis ◽  
Alternative Treatment Option

Introduction: Esophagogastric bleeding is the most formidable complication of the portal hypertension syndrome. At acute bleeding from varicose veins of the esophagus and stomach, mortality reaches 40 to 50% and is accompanied with the high risk of early hemorrhage recurrence in 30-50 % of survivors. Portosystemic shunt surgery provides for radical decompression of the portal vein system and reliably prevent hemorrhage recurrence. Purpose: To assess the possibility and efficacy of the Distal Splenorenal Anastomosis (DSRA) with a minimally invasive laparoscopic approach. Methods: The study included 28 patients with portal hypertension syndrome who underwent laparoscopic DSRA. By the Child-Pugh scale, class A was 42.9%, class B - 57.1%. The indication for surgical decompression of the portal system was the ineffectiveness of repeated sessions of endoscopic ligation with recurrence of varicose veins of the esophagus (21.5%) and/or bleeding from them (46.4%) or the presence of varicose veins of the stomach (32.1%). Results: Mean surgery time was 294±86 minutes. The maximum blood loss was 211±55 ml. The access conversion was performed in 10.7% of cases. In the postoperative period, the patients were in ICU for 1-2 days. The hospital stay and in-patients treatment duration was 9.4±2.5 days. Both in the early and in the long-term follow-up, there were no cases of gastroesophageal bleeding and shunt thrombosis. The portosystemic encephalopathy developed in 12% of cases. The surgical decompression of the portal system was featured by a decrease in the degree of esophagus varication in the long-term period. The maximum follow-up period was 46 months. Conclusion: Minimally invasive laparoscopic DSRA in patients with portal hypertension syndrome is a possible, safe and effective alternative treatment option.

scholarly journals Distal bypass with a varicose vein graft for critical limb ischemia: report of a case

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Atsushi Guntani ◽  
Ryosuke Yoshiga ◽  
Shinsuke Mii
Keyword(s):  
Varicose Vein ◽  
Lower Limb ◽  
Vein Graft ◽  
Bypass Surgery ◽  
Varicose Veins ◽  
Graft Infection ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Case Presentation

Abstract Background A saphenous vein complicated with varicose veins is generally thought to be unsuitable for bypass grafting. Case presentation A patient who developed sepsis due to lower limb gangrene was successfully treated by endovascular treatment and bypass surgery using a varicose vein graft. There were no complications, such as occlusion or aneurysm, of the varicose vein graft during the 2-year follow-up period. Conclusions We herein report a case in which bypass surgery with a varicose vein graft was used to avoid major amputation of the lower limb, and the patient recovered markedly from sepsis. If there are no other appropriate autologous veins for revascularization of lower limb gangrene, a varicose vein graft may be useful as a conduit for bypass surgery at risk of graft infection.

scholarly journals Thirty-year follow-up after extracranial–intracranial bypass surgery

2008 ◽  
Vol 24 (2) ◽  
pp. E19 ◽  
Author(s):  
O. Howard Reichman ◽  
Edward A. M. Duckworth ◽  
Douglas E. Anderson ◽  
Thomas C. Origitano
Keyword(s):  
Clinical Experience ◽  
Bypass Surgery ◽  
Multicenter Trial ◽  
Conventional Wisdom ◽  
International Multicenter

✓The conventional wisdom resulting from the international, multicenter, trial of extracranial–intracranial bypass surgery is that this procedure offers no benefit. Because of the complex and unique circumstances of some, clinical experience and judgment must sometimes overrule some statistical conclusions.

scholarly journals THE EFFECTIVENESS OF SPLENORENAL SHUNT IN TREATMENT OF PREHEPATIC PORTAL HYPERTENSION IN CHILDREN

2021 ◽  
Vol 29 (5) ◽  
pp. 565-572
Author(s):  
R.V. Zhezhera ◽  
◽  
Keyword(s):  
Blood Flow ◽  
Portal Hypertension ◽  
Varicose Veins ◽  
Portosystemic Shunt ◽  
Splenorenal Shunt ◽  
Portal System ◽  
Recurrent Bleeding ◽  
Esophageal Variceal ◽  
Results Of Treatment

Objective. To evaluate the results of treatment of prehepatic portal hypertension (PPH) in children by method of side-to-side splenorenal bypass. Methods. A retrospective, monocentric analysis of 114 patients with prehepatic portal hypertension was carried out in the period from 2000 to 2018. The age of the patients was from 6 months up to 18 years, the average age 10,1±3,8 years (M±σ). All patients underwent side-to-side splenorenal shunt. In the postoperative period, on the 7<sup>th</sup> day, ultrasound examination of the abdominal organs with Doppler sonography (US) was performed to assess the volume of the spleen, the rate of portohepatic perfusion, the rate of blood flow along the side-to-side splenorenal shunt, as well as to assess its diameter. Control US was performed after the 1<sup>st</sup>, 3<sup>rd</sup>, 6<sup>th</sup>, 12<sup>th</sup> months; to assess the regression of esophageal and gastric varicose veins, the control esophagogastroduodenoscopy (EYD) was performed after 3<sup>rd</sup> , 6<sup>th</sup>, 12<sup>th</sup> months and then once a year. Subsequently, the control examination of the patients was carried out once a year. The follow-up was 2-18 years. Results. Out of 114 patients who underwent side - to - side splenorenal shunt, 5 (4,4%) patients had recurrent bleeding from the esophageal variceal vein at the follow-up period (2-18 years). One patient had intra-abdominal arrosive bleeding from side-to-side splenorenal shunt provoked by severe postoperative pancreatitis. The average diameter of the shunt was 12±1.9 mm. The spleen volume decreased by 39.7±10.3%. Portohepatic perfusion reduced by 39% in comparison with the indicators before surgery. The blood flow rate along the side -to-side splenorenal shunt was 2403±557.3 ml/min. in 95,4% of patients the regression of variceal vein was noted. Hypersplenism syndrome was arrested in 73.6% of children. Conclusion. Side -to- side splenorenal shunt is considered to be an effective method of portal decompression with the effectiveness inpreventingboth esophageal and gastricvariceal veins bleeding in 95,4% of patients. What this paper adds The results of treatment of the prehepatic portal hypertension by method of side-to-side splenorenal shunt have been firstly analyzed, and the effect of this variant of portosystemic shunt on portohepatic perfusion has been assessed. It has been established that this option of shunt is effective for the portal system decompression and occupies an intermediate position between selective and total variant of portosystemic shunt.

scholarly journals Successful treatment of gastric bleeding due to left-sided portal hypertension by transcatheter arterial embolization (clinical case report)

2021 ◽  
Vol 24 (1) ◽  
pp. 4-9
Author(s):  
Georgy I. Sinenchenko ◽  
Vladimir G. Verbitsky ◽  
Andrey E. Demko ◽  
Aleksey N. Sekeev ◽  
Sergey A. Alentyev ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
High Risk ◽  
Transcatheter Arterial Embolization ◽  
Varicose Veins ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Recurrent Bleeding ◽  
Gastric Bleeding ◽  
Stomach Fundus

Objective: to evaluate the results of transcatheter arterial embolization in patients with acute and chronic pancreatitis complicated by left-sided portal hypertension and bleeding from varicose veins of the stomach fundus and body. Materials and methods: 5 patients with left-sided portal hypertension were treated. Patients were admitted with a clinical picture of gastrointestinal bleeding, which was confirmed by laboratory and instrumental methods of research. Fibrogastroduodenoscopy revealed bleeding from varicose veins of the fundus and body of the stomach in all patients. The average age was 55.4±3.1 years. Results. All patients showed varicose veins of the fundus and body of the stomach, with signs of bleeding. Due to the high risk of recurrent bleeding, subtractive digital angiography with no signs of contrast agent extravasation was performed, followed by spiral embolization of the splenic artery in the proximal third until the blood flow was stopped. The technical and clinical success rate was 100%. Conclusion. Endovascular methods of treatment for left-sided portal hypertension syndrome are minimally invasive but highly effective methods of hemostasis. The indication for their use is unsuccessful endoscopic hemostasis or high risk of recurrence of bleeding from varicose veins of the fundus and body of the stomach.

scholarly journals Correction of complications portal hypertension syndrome

2018 ◽  
Vol 20 (1) ◽  
pp. 127-131
Author(s):  
S Ya Ivanusa ◽  
I E Onnicev ◽  
A V Khokhlov ◽  
A V Yankovsky
Keyword(s):  
Portal Hypertension ◽  
Splenic Artery ◽  
Varicose Veins ◽  
Intraoperative Complications ◽  
Hospital Treatment ◽  
Treatment Responses ◽  
Endoscopic Ligation ◽  
Lumbar Triangle ◽  
Artery Resection

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.

One Month Follow-up of Haemostatic Variables in Patients Undergoing Aortocoronary Bypass Surgery

1995 ◽  
Vol 73 (03) ◽  
pp. 356-361 ◽  
Author(s):  
L Mannucci ◽  
P S Gerometta ◽  
L Mussoni ◽  
C Antona ◽  
A Parolari ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Bypass Surgery ◽  
Fibrinolytic System ◽  
Aortocoronary Bypass ◽  
Protamine Sulphate ◽  
Aortocoronary Bypass Surgery ◽  
Intraoperative Period ◽  
Pai 1 ◽  
D Dimer

SummaryIt is already known that activation of the coagulation and fibrinolytic system occurs in patients undergoing cardiopulmonary bypass (CPB). We have thus studied twenty patients (10 treated with aprotinin during CPB and 10 untreated) both during the intraoperative period and during thirty days follow up. In untreated patients D-dimer levels increased 4-fold during CPB and the levels were above baseline for the whole follow up (p<0.0001). D-dimer levels were reduced in aprotinin treated patients in comparison to untreated patients (p = 0.0172); levels then gradually increased to the values of the untreated patients over the following 24 h later and remained higher during the thirty day follow up. The behavior of haemostatic variables in the 24 h after CPB did not vary between untreated and aprotinin treated patients. In particular, five minutes after protamine sulphate administration, levels of F1 + 2 and TAT rose significantly (p = 0.0054, p = 0.0022 respectively), whereas fibrinogen significantly decreased (p<0.0001) and PAI-1 antigen levels were reduced. Two days after CPB the concentrations of F1 + 2 and TAT lowered, whereas fibrinogen and PAI-1 antigen levels increased. On the 5th, 8th and 30th days after CPB, F1 + 2 and TAT levels remained higher than those reported at baseline in both groups of patients, whereas fibrinogen levels increased over basal levels in aprotinin treated patients only.Thus, in addition to the activation of the coagulation and fibrinolytic system occurring during the intraoperative period, in patients undergoing CPB, there are alterations of haemostatic variables up to thirty days from surgery.

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