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

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

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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.

Original languageEnglish
Pages (from-to)114-126
Number of pages13
JournalSurgical endoscopy
Volume32
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

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Esophageal and Gastric Varices
Splenectomy
Blood Vessels
Anatomy
Stomach
Veins
Drainage
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Surgery

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Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy. / Kawanaka, Hirofumi; Akahoshi, Tomohiko; Nagao, Yoshihiro; Kinjo, Nao; Yoshida, Daisuke; Matsumoto, Yoshihiro; Harimoto, Norifumi; Itoh, Shinji; Yoshizumi, Tomoharu; Maehara, Yoshihiko.

In: Surgical endoscopy, Vol. 32, No. 1, 01.01.2018, p. 114-126.

Research output: Contribution to journalArticle

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AU - Nagao, Yoshihiro

AU - Kinjo, Nao

AU - Yoshida, Daisuke

AU - Matsumoto, Yoshihiro

AU - Harimoto, Norifumi

AU - Itoh, Shinji

AU - Yoshizumi, Tomoharu

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