Annals of hepato-biliary-pancreatic surgery最新文献

{"title":"Prognostication for recurrence patterns after curative resection for pancreatic ductal adenocarcinoma.","authors":"Andrew Ang, Athena Michaelides, Claude Chelala, Dayem Ullah, Hemant M Kocher","doi":"10.14701/ahbps.23-149","DOIUrl":"10.14701/ahbps.23-149","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>This study aimed to investigate patterns and factors affecting recurrence after curative resection for pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Methods: </strong>Consecutive patients who underwent curative resection for PDAC (2011-21) and consented to data and tissue collection (Barts Pancreas Tissue Bank) were followed up until May 2023. Clinico-pathological variables were analysed using Cox proportional hazards model.</p><p><strong>Results: </strong>Of 91 people (42 males [46%]; median age, 71 years [range, 43-86 years]) with a median follow-up of 51 months (95% confidence intervals [CIs], 40-61 months), the recurrence rate was 72.5% (n = 66; 12 loco-regional alone, 11 liver alone, 5 lung alone, 3 peritoneal alone, 29 simultaneous loco-regional and distant metastases, and 6 multi-focal distant metastases at first recurrence diagnosis). The median time to recurrence was 8.5 months (95% CI, 6.6-10.5 months). Median survival after recurrence was 5.8 months (95% CI, 4.2-7.3 months). Stratification by recurrence location revealed significant differences in time to recurrence between loco-regional only recurrence (median, 13.6 months; 95% CI, 11.7-15.5 months) and simultaneous loco-regional with distant recurrence (median, 7.5 months; 95% CI, 4.6-10.4 months; <i>p</i> = 0.02, pairwise log-rank test). Significant predictors for recurrence were systemic inflammation index (SII) ≥ 500 (hazard ratio [HR], 4.5; 95% CI, 1.4-14.3), lymph node ratio ≥ 0.33 (HR, 2.8; 95% CI, 1.4-5.8), and adjuvant chemotherapy (HR, 0.4; 95% CI, 0.2-0.7).</p><p><strong>Conclusions: </strong>Timing to loco-regional only recurrence was significantly longer than simultaneous loco-regional with distant recurrence. Significant predictors for recurrence were SII, lymph node ration, and adjuvant chemotherapy.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"248-261"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcome and risk scoring to predict survival after hepatic resection for hepatocellular carcinoma with portal vein tumor thrombosis.","authors":"Tae-Seok Kim, Kwangho Yang, Gi Hong Choi, Hye Yeon Yang, Dong-Sik Kim, Hye-Sung Jo, Gyu-Seong Choi, Kwan Woo Kim, Young Chul Yoon, Jaryung Han, Doo Jin Kim, Shin Hwang, Koo Jeong Kang","doi":"10.14701/ahbps.24-048","DOIUrl":"10.14701/ahbps.24-048","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is classified as the advanced stage (BCLC stage C) with extremely poor prognosis, and in current guidelines is recommended for systemic therapy. This study aimed to evaluate the surgical outcomes and long-term prognosis after hepatic resection (HR) for patients who have HCC combined with PVTT.</p><p><strong>Methods: </strong>We retrospectively analyzed 332 patients who underwent HR for HCC with PVTT at ten tertiary referral hospitals in South Korea.</p><p><strong>Results: </strong>The median overall and recurrence-free survival after HR were 32.4 and 8.6 months, while the 1-, 3-, and 5-year overall survival rates were 75%, 48%, and 39%, respectively. In multivariate analysis, tumor number, tumor size, AFP, PIVKA-II, neutrophil-to-lymphocyte ratio, and albumin-bilirubin (ALBI) grade were significant prognostic factors. The risk scoring was developed using these seven factors-tumor, inflammation and hepatic function (TIF), to predict patient prognosis. The prognosis of the patients was well stratified according to the scores (log-rank test, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>HR for patients who have HCC combined with PVTT provided favorable survival outcomes. The risk scoring was useful in predicting prognosis, and determining the appropriate treatment strategy for those patients who have HCC with PVTT.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"134-143"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice guidelines for managing extrahepatic biliary tract cancers.","authors":"Hyung Sun Kim, Mee Joo Kang, Jingu Kang, Kyubo Kim, Bohyun Kim, Seong-Hun Kim, Soo Jin Kim, Yong-Il Kim, Joo Young Kim, Jin Sil Kim, Haeryoung Kim, Hyo Jung Kim, Ji Hae Nahm, Won Suk Park, Eunkyu Park, Joo Kyung Park, Jin Myung Park, Byeong Jun Song, Yong Chan Shin, Keun Soo Ahn, Sang Myung Woo, Jeong Il Yu, Changhoon Yoo, Kyoungbun Lee, Dong Ho Lee, Myung Ah Lee, Seung Eun Lee, Ik Jae Lee, Huisong Lee, Jung Ho Im, Kee-Taek Jang, Hye Young Jang, Sun-Young Jun, Hong Jae Chon, Min Kyu Jung, Yong Eun Chung, Jae Uk Chong, Eunae Cho, Eui Kyu Chie, Sae Byeol Choi, Seo-Yeon Choi, Seong Ji Choi, Joon Young Choi, Hye-Jeong Choi, Seung-Mo Hong, Ji Hyung Hong, Tae Ho Hong, Shin Hye Hwang, In Gyu Hwang, Joon Seong Park","doi":"10.14701/ahbps.23-170","DOIUrl":"10.14701/ahbps.23-170","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021.</p><p><strong>Methods: </strong>Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop.</p><p><strong>Results: </strong>In November 2021, the finalized draft was presented for public scrutiny during a formal hearing.</p><p><strong>Conclusions: </strong>The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"161-202"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival benefit of neoadjuvant FOLFIRINOX for patients with borderline resectable pancreatic cancer.","authors":"Evelyn Waugh, Juan Glinka, Daniel Breadner, Rachel Liu, Ephraim Tang, Laura Allen, Stephen Welch, Ken Leslie, Anton Skaro","doi":"10.14701/ahbps.23-107","DOIUrl":"10.14701/ahbps.23-107","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>While patients with borderline resectable pancreatic cancer (BRPC) are a target population for neoadjuvant chemotherapy (NAC), formal guidelines for neoadjuvant therapy are lacking. We assessed the perioperative and oncological outcomes in patients with BRPC undergoing NAC with FOLFIRINOX for patients undergoing upfront surgery (US).</p><p><strong>Methods: </strong>The AHPBA criteria for borderline resectability and/or a CA19-9 level > 100 μ/mL defined borderline resectable tumors retrieved from a prospectively populated institutional registry from 2007 to 2020. The primary outcome was overall survival (OS) at 1 and 3 years. A Cox Proportional Hazard model based on intention to treat was used. A receiver-operator characteristics (ROC) curve was constructed to assess the discriminatory capability of the use of CA19-9 > 100 μ/mL to predict resectability and mortality.</p><p><strong>Results: </strong>Forty BRPC patients underwent NAC, while 46 underwent US. The median OS with NAC was 19.8 months (interquartile range [IQR], 10.3-44.24) vs. 10.6 months (IQR, 6.37-17.6) with US. At 1 year, 70% of the NAC group and 41.3% of the US group survived (<i>p</i> = 0.008). At 3 years, 42.5 % of the NAC group and 10.9% of the US group survived (<i>p</i> = 0.001). NAC significantly reduced the hazard of death (adjusted hazard ratio, 0.20; 95% confidence interval, 0.07-0.54; <i>p</i> = 0.001). CA19-9 > 100 μ/mL showed poor discrimination in predicting mortality, but was a moderate predictor of resectability.</p><p><strong>Conclusions: </strong>We found a survival benefit of NAC with FOLFIRINOX for BRPC. Greater pre-treatment of CA19-9 and multivessel involvement on initial imaging were associated with progression of the disease following NAC.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"229-237"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of laparoscopic excision of choledochal cyst, hepaticojejunostomy, and Roux-en-Y anastomosis using Artisential^®.","authors":"Younghoon Shim, Chang Moo Kang","doi":"10.14701/ahbps.23-114","DOIUrl":"10.14701/ahbps.23-114","url":null,"abstract":"<p><p>Choledochal cyst is a condition involving an abnormal dilation of the bile ducts, which can lead to various symptoms and comorbidities, including cancer. The treatment of choice for choledochal cyst is surgical correction including choledochal cyst excision and Roux-en-y hepaticoenterostomy. Minimal invasive methods like laparoscopic methods or robotic methods are used for surgical correction of choledochal cysts; however, it is still controversial which method is superior. A Korean company, LIVESMED, developed Artisential^®, a laparoscopic surgical instrument that can overcome the drawbacks of laparoscopic methods. This article presents a case of the first Artisential^®-performed surgical excision of a choledochal cyst and hepaticojejunostomy.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"266-269"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreaticoduodenectomy with superior mesenteric artery first-approach combined total meso-pancreas excision for periampullary malignancies: A high-volume single-center experience with short-term outcomes.","authors":"Thanh Khiem Nguyen, Ham Hoi Nguyen, Tuan Hiep Luong, Kim Khue Dang, Van Duy Le, Duc Dung Tran, Van Minh Do, Hong Quang Pham, Hoan My Pham, Thi Lan Tran, Cuong Thinh Nguyen, Hong Son Trinh, Yosuke Inoue","doi":"10.14701/ahbps.23-068","DOIUrl":"10.14701/ahbps.23-068","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Pancreaticoduodenectomy (PD) is the only radical treatment for periampullary malignancies. Superior mesenteric artery (SMA) first approach combined with total meso-pancreas (MP) excision was conducted to improve the oncological results. There has not been any previous research of a technique that combines the SMA first approach and total MP excision with a detailed description of the MP macroscopical shape.</p><p><strong>Methods: </strong>We prospectively assessed 77 patients with periampullary malignancies between October 2020 and March 2022 (18 months). All patients had undergone PD with SMA first approach combined total MP excision. The perioperative indications, clinical data, intra-operative index, R0 resection rate of postoperative pathological specimens (especially mesopancreatic margin), postoperative complications, and follow-up results were evaluated.</p><p><strong>Results: </strong>The median operative time was 289.6 min (178-540 min), the median intraoperative blood loss was 209 mL (30-1,600 mL). Microscopically, there were 19 (24.7%) cases with metastatic MP, and five cases (6.5%) with R1-resection of the MP. The number of lymph nodes (LNs) harvested and metastatic LNs were 27.2 (maximum was 74) and 1.8 (maximum was 16), respectively. Some (46.8%) patients had pancreatic fistula, but mostly in grade A, with 7 patients (9.1%) who required re-operations. Some 18.2% of cases developed postoperative refractory diarrhea. The rate of in-hospital mortality was 1.3%.</p><p><strong>Conclusions: </strong>The PD with SMA first approach combined TMpE for periampullary malignancies was effective in achieving superior oncological statistics (rate of MP R0-resection and number of total resected LNs) with non-inferior short-term outcomes. It is necessary to evaluate survival outcomes with long-term follow-up.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"59-69"},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Port-site metastasis after laparoscopic radical pancreatosplenectomy in left-sided pancreatic cancer.","authors":"Su Hyeong Park, Zhanay Zhassanov, Chang Moo Kang","doi":"10.14701/ahbps.23-092","DOIUrl":"10.14701/ahbps.23-092","url":null,"abstract":"<p><p>Despite debates regarding the safety of well-selected left-sided pancreatic cancer, minimally invasive distal pancreatosplenectomy is considered safer and more effective than open distal pancreatosplenectomy in well-selected patients. Previous studies have shown that minimally invasive surgery yields comparable oncologic outcomes to open surgery. While patients who undergo minimally invasive distal pancreatosplenectomy also experience recurrences and metastases after surgery, port-site metastasis is particularly rare. In this report, we report an extremely rare case of port-site metastasis following minimally invasive distal pancreatosplenectomy for left-sided pancreatic cancer.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"104-108"},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study.","authors":"Thomas B Russell, Peter L Labib, Paula Murphy, Fabio Ausania, Elizabeth Pando, Keith J Roberts, Ambareen Kausar, Vasileios K Mavroeidis, Gabriele Marangoni, Sarah C Thomasset, Adam E Frampton, Pavlos Lykoudis, Manuel Maglione, Nassir Alhaboob, Hassaan Bari, Andrew M Smith, Duncan Spalding, Parthi Srinivasan, Brian R Davidson, Ricky H Bhogal, Daniel Croagh, Ismael Dominguez, Rohan Thakkar, Dhanny Gomez, Michael A Silva, Pierfrancesco Lapolla, Andrea Mingoli, Alberto Porcu, Nehal S Shah, Zaed Z R Hamady, Bilal Al-Sarrieh, Alejandro Serrablo, Somaiah Aroori","doi":"10.14701/ahbps.23-071","DOIUrl":"10.14701/ahbps.23-071","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>After pancreatoduodenectomy (PD), an early oral diet is recommended; however, the postoperative nutritional management of PD patients is known to be highly variable, with some centers still routinely providing parenteral nutrition (PN). Some patients who receive PN experience clinically significant complications, underscoring its judicious use. Using a large cohort, this study aimed to determine the proportion of PD patients who received postoperative nutritional support (NS), describe the nature of this support, and investigate whether receiving PN correlated with adverse perioperative outcomes.</p><p><strong>Methods: </strong>Data were extracted from the Recurrence After Whipple's study, a retrospective multicenter study of PD outcomes.</p><p><strong>Results: </strong>In total, 1,323 patients (89%) had data on their postoperative NS status available. Of these, 45% received postoperative NS, which was \"enteral only,\" \"parenteral only,\" and \"enteral and parenteral\" in 44%, 35%, and 21% of cases, respectively. Body mass index < 18.5 kg/m² (<i>p</i> = 0.03), absence of preoperative biliary stenting (<i>p</i> = 0.009), and serum albumin < 36 g/L (<i>p</i> = 0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication, i.e., those who had a relatively uneventful recovery, 20% received PN.</p><p><strong>Conclusions: </strong>A considerable number of patients who had an uneventful recovery received PN. PN is not without risk, and should be reserved for those who are unable to take an oral diet. PD patients should undergo pre- and postoperative assessment by nutrition professionals to ensure they are managed appropriately, and to optimize perioperative outcomes.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"70-79"},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138809848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended left hepatectomy associated with resection of the vena cava and suprahepatic veins by in situ perfusion to treat intrahepatic cholangiocarcinoma.","authors":"Caroline Celestino Girão Nobre, Raquel Lima Sampaio, Ana Clemilda Marques Ximenes, Gustavo Rego Coelho, José Huygens Parente Garcia","doi":"10.14701/ahbps.23-102","DOIUrl":"10.14701/ahbps.23-102","url":null,"abstract":"<p><p>Cholangiocarcinoma is a heterogeneous group of aggressive tumors that correspond to the second most common primary liver tumor. They can be classified according to their anatomical position concerning the biliary tree, and each subtype demonstrates different behavior and treatment. A 38-year-old male patient presenting solely right lumbar pain was diagnosed with a 7 cm hepatic tumor involving segments I, Iva, and VIII associated with involvement of the hepatic veins. He underwent a bloc resection of hepatic segments I, II, III, IV, partial V, partial VII, and VIII; right, middle, and left hepatic veins; and inferior vena cava segment, with perfusion of the remaining liver in situ with a preservation solution. As the patient had a large accessory inferior right hepatic vein draining the remaining liver, no reimplantation of hepatic veins was necessary. He remained clinically stable in outpatient follow-up, with excellent performance status-current survival of 2 years 6 months after surgical treatment.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"109-113"},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139426194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early mobilization and delayed arterial ligation (EMDAL) as a surgical technique for splenectomy and shunt surgery in portal hypertension.","authors":"Harilal S L, Biju Pottakkat, Kalayarasan Raja, Senthil Gnanasekaran","doi":"10.14701/ahbps.23-080","DOIUrl":"10.14701/ahbps.23-080","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Splenectomy is the most frequently performed procedure as definitive management or as part of shunt surgery or devascularization in portal hypertension. Splenectomy is technically challenging because of the frequent coexistence of multiple collateral varices, splenomegaly, poor liver function, and thrombocytopenia. Early arterial ligation and late mobilization (EALDEM) is the traditional method for splenectomy in portal hypertension. Early spleen mobilization offers good control of the hilum. We aim to compare the effect of the early mobilization and delayed arterial ligation (EMDAL) technique with that of the conventional splenectomy technique in patients with portal hypertension.</p><p><strong>Methods: </strong>During the study period from September 2011 to September 2022, 173 patients underwent surgical intervention for portal hypertension at our institution. Among these patients, 114 underwent the conventional method of splenectomy (early arterial ligation and late splenic mobilization) while 59 underwent splenectomy with the EMDAL technique. Demographics were compared between the two groups. Intraoperative and postoperative outcomes were analyzed using the Mann-Whitney test in each group. A minimum follow-up of 12 months was performed in each group.</p><p><strong>Results: </strong>Demographics and type of surgical procedure were comparable in the two surgical method groups. Median blood loss was higher in the conventional group than in the EMDAL method. The median duration of surgery was comparable in the two surgical procedures. Clavien-Dindo grade III/IV complications were reported more frequently in the conventional group.</p><p><strong>Conclusions: </strong>The splenic hilum can be controlled well and bleeding can be minimised with early mobilization and delayed arterial ligation.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"48-52"},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}