Distal splenorenal shunt with splenopancreatic disconnection for portal hypertension in biliary atresia View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

1999-03

AUTHORS

T. Hasegawa, H. Tamada, Y. Fukui, H. Tanano, A. Okada

ABSTRACT

This study evaluated the long-term effects of distal splenorenal shunt with splenopancreatic disconnection (DSRS-SPD) on portal hypertension (PH) in biliary atresia (BA) patients. Five patients with BA underwent DSRS-SPD at the age of 3.3 to 8.5 years. They had been free from jaundice after hepatic portoenterostomy (HPE); however, they gradually developed gastroesophageal varices and hypersplenism. Portal venous pressure after anastomosis was 37.2 ± 6.1 cmH2O, as high as that before anastomosis (37.8 ± 3.3 cmH2O). Postoperatively, liver function tests became worse within 2 weeks; however, they returned to preoperative levels within 1 month without any further treatment. No patient developed a significant encephalopathy throughout the observed period. During follow-up of 4 to 12 years, the shunt was patent in all patients. Spleen size decreased after operation. Abdominal-wall venous dilatation completely disappeared in two of four patients. The platelet counts gradually increased and were significantly higher 3 years (126.6 ± 59.3 × 103/mm3) after DSRS-SPD than preoperative values (66.0 ± 24.2 × 103/mm3). White blood cell counts showed no significant changes. No patient developed a gastrointestinal hemorrhage postoperatively, although three had had repeated hemorrhages before the operation. Two patients showed disappearance of varices endoscopically at 2 years and 7 months after DSRS-SPD, respectively, but had recurrent varices at 7 and 11 years, respectively. The endoscopic findings regarding varices 3 to 7 years after DSRS-SPD were as follows: decreased number (80%); decreased length (40%); improvement of form (20%); improvement of fundamental color (60%); disappearance of red-color sign (100%); disappearance of gastric varices (75%); and disappearance of acute gastric mucosal lesions (100%). Although one patient later underwent liver transplantation because of progression of liver cirrhosis, all five are doing well. From these results, DSRS-SPD may prove to be a safe and feasible procedure for intrahepatic PH after HPE for BA and may improve gastroesophageal varices and hypersplenism on long-term follow-up. More... »

PAGES

92-96

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s003830050524

DOI

http://dx.doi.org/10.1007/s003830050524

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1049319325

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/10079338


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