Clinical analysis of pericardial devascularization by preserving vagus trunks in 42 patients with portal hypertension.
Pericardial devascularization (PD) is less of a burden and provides better bleeding control to patients compared to shunt procedures, and so has been widely used in portal hypertension in China. However, because the vagus trunks are interrupted during surgery, patients easily suffer from postoperative stomach adynamia. Based on our understanding from autopsy of the path of vagus trunks along the distal oesophagus, we designed the operative procedure of PD by preserving vagus trunks (PDPVT) to treat portal hypertension. Between May 1991 and January 2003, patients with portal hypertension were treated surgically using PDPVT (n = 42), single PD (n = 32), or PD with pyloroplasty (PD+PP; n = 16). Operative mortality was 2.4% in the PDPVT group and 6.3% in both the PD and PD+PP groups (p > 0.05). The postoperative rebleeding rate was 9.5% in the PDPVT group and 12.5% in both the PD and PD+PP groups (p > 0.05). There were no differences in operative time and estimated blood loss between the three groups (p > 0.05). The recovery time for gastroenteric function was shorter with PDPVT (mean, 3.5 days) than with PD (mean, 5.7 days) and PD+PP (mean, 4.2 days; p < 0.02). Incidences of early satiety and enterogastric reflux were significantly lower in the PDPVT group (both 4.8%) than in the PD group (46.9% and 18.8%) and PD+PP group (12.5% and 100%; p < 0.005). Incidences of retention of gastric juice, diarrhoea and late gallstones were 12.5%, 15.6% and 7.1%, respectively, in the PD group, and 12.5%, 18.8% and 6.3%, respectively, in the PD+PP group, but none of these were observed in the PDPVT group. Since it preserves vagus trunks, PDPVT can maintain normal stomach dynamics and physiological function of hepatobiliary and gut systems better than PD and PD+PP, thus reducing incidences of postoperative complications. Thus, PDPVT is superior to PD and PD+PP in the treatment of portal hypertension.
Dong
Yong-Hong
YH
Hepatobiliary Department, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Lu
Yun-Fu
YF
Qiu
Qing'an
Q
Huang
Hai
H
Wei
Hong
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002299:Cardia / Q000098:blood supply* / Q000294:innervation / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004285:Dogs; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000098:blood supply / Q000294:innervation / Q000601:surgery; D014630:Vagus Nerve / Q000601:surgery*