Novel technique of laparoscopic azygoportal disconnection for treatment of esophageal varicosis: preliminary experience with five patients.
BACKGROUND
Liver cirrhosis leads frequently to the development of ascites and a formation of varicose veins in the esophagus. The latter presents increased mortality risk. Recently, significant progress in laparoscopic technology enabled devascularization of the proximal stomach in a less invasive way. The results experienced by five patients are presented.


METHODS
Laparoscopic azygoportal disconnection was performed by means of novel technique (Danis procedure) in five men with esophagus varices bleeding (2nd to 11th events) and liver cirrhosis stage Child-Pugh B and C. This procedure was performed after all other methods had either failed to prevent recurrent bleeding or were refused by the patient. Five ports were positioned on the upper abdominal wall. The veins in the lesser omentum were divided by means of the LigaSure-Atlas device. The stomach coronary vein was visualized, and all the proximal branches toward the esophagus as well as the short gastric vessels were divided. The diaphragm hiatus was opened, and the distal esophagus was dissected. The paraesophageal venous collaterals also were divided, and the remaining varicose veins of the esophagus were interrupted by transmural stitching.


RESULTS
All the patients survived the minimally invasive procedure. Two of them died 9 and 16 months after surgery, respectively, because of liver insufficiency. No bleeding event from varicose veins in the esophagus occurred postoperatively.


CONCLUSIONS
Laparoscopic azygoportal disconnection is a less invasive method for prevention of rebleeding from varicose veins in the esophagus. Further studies are necessary to confirm these preliminary results.
Danis
J
J
Second Department of Surgery, General Hospital and Ludwig Boltzmann Institute for Operative Laparoscopy, A 4020 Linz, Krankenhausstr. 9, Austria. Jan.Danis@akh.Linz.at
Hubmann
R
R
Pichler
P
P
Shamiyeh
A
A
Wayand
W U
WU
D000328:Adult; D001401:Azygos Vein / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery*; D004947:Esophagus / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009196:Myeloproliferative Disorders / Q000150:complications; D009852:Omentum / Q000098:blood supply; D011169:Portal Vein / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical; D012008:Recurrence; D013270:Stomach / Q000098:blood supply; D016896:Treatment Outcome