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

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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.

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Acknowledgements

This work was partly supported by a Grant-in-Aid for Scientific Research (Grant 15K10169) from the Japan Society for the Promotion of Science and the Uehara Memorial Foundation.

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

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

  2. Clinical Research Institute and Department of Surgery, National Beppu Medical Center, 1473 Uchikamado, Beppu, 874-0011, Japan

    Hirofumi Kawanaka

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  1. Hirofumi Kawanaka
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Contributions

Author's contributions

All authors have made meaningful contributions to this study and approved the final version of this manuscript. KH, AT, NY, KN, YD, MY, HN, IS, and YT performed the operation. KH, AT, NY, KN, YD, MY, HN, IS, YT and MY designed the study. KH, AT, NY, KN, YD, MY, HN, IS, YT and MY collected and analyzed the data. KH, AT, NY, KN, YD, MY, HN, IS, YT and MY participated in drafting or revising the paper.

Corresponding author

Correspondence to Hirofumi Kawanaka.

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Disclosures

Drs. Hirofumi Kawanaka, Tomohiko Akahoshi, Yoshihiro Nagao, Nao Kinjo, Daisuke Yoshida, Yoshihiro Matsumoto, Norifumi Harimoto, Shinji Itoh, Tomoharu Yoshizumi, Yoshihiko Maehara have no conflicts of interest or financial ties to disclose.

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Kawanaka, H., Akahoshi, T., Nagao, Y. et al. Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy. Surg Endosc 32, 114–126 (2018). https://doi.org/10.1007/s00464-017-5646-2

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  • DOI: https://doi.org/10.1007/s00464-017-5646-2

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