Abstract | BACKGROUND: Esophagogastric variceal bleeding is the most common lethal factor for patients with cirrhotic portal hypertension. We firstly developed a laparoscopic splenectomy and azygoportal disconnection ( LSD) with intraoperative endoscopic variceal ligation (LSDL) technique. In this study, we aimed to evaluate whether LSDL is feasible and safe and whether LSDL can effectively prevent esophagogastric variceal re- bleeding (EVR), as compared with single LSD. METHODS: In this randomized controlled single-center study, 88 patients with cirrhosis who had esophagogastric variceal bleeding and hypersplenism were randomly assigned to receive either LSD (n = 44) or LSDL (n = 44) between January 2020 and December 2021. The primary outcome was EVR. RESULTS: No patients withdrew from the study. There were no significant differences in estimated blood loss, incidence of blood transfusion, time to first flatus and off-bed activity, or postoperative hospital stay between the two groups. Compared with that in the LSD group, operation time was significantly longer in the LSDL group (138.5 ± 19.4 min vs. 150.3 ± 19.0 min, P < 0.05); however, LSDL was associated with a significantly decreased EVR rate at 1-year follow-up (8/44 vs. 1/44, P < 0.05). Univariate analysis and multivariate logistic regression revealed that LSDL was a significant independent protective factor against EVR in comparison with LSD (relative risk: 0.105, 95% confidence interval 0.012-0.877; P = 0.037). CONCLUSIONS: Our newly developed LSDL procedure is not only technically feasible and safe; it also contributed to lowering the EVR risk more so than single LSD. TRIAL REGISTRATION: We registered our research at https://www. CLINICALTRIALS: gov/ . The name of research registered is "Laparoscopic Splenectomy and Azygoportal Disconnection with Intraoperative Endoscopic Variceal Ligation." The trial registration identifier at clinicaltrials.gov is NCT04244487.
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Authors | Dou-Sheng Bai, Sheng-Jie Jin, Xiao-Xing Xiang, Jian-Jun Qian, Chi Zhang, Bao-Huan Zhou, Tian-Ming Gao, Guo-Qing Jiang |
Journal | Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
(J Gastrointest Surg)
Vol. 26
Issue 9
Pg. 1838-1845
(09 2022)
ISSN: 1873-4626 [Electronic] United States |
PMID | 35676457
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | © 2022. The Society for Surgery of the Alimentary Tract. |
Topics |
- Humans
- Azygos Vein
(surgery)
- Esophageal and Gastric Varices
(complications, surgery)
- Gastrointestinal Hemorrhage
(etiology)
- Laparoscopy
(methods)
- Ligation
(adverse effects)
- Liver Cirrhosis
(complications)
- Splenectomy
(methods)
- Vagus Nerve
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