title: Appraisal of DSRS with SPGD for esophagogastric varices: a retrospective comparative study according to the underlying liver diseases.
abstract: OBJECTIVE
  The differences in long-term results of distal splenorenal shunt with splenopancreatic and gastric disconnection (DSRS with SPGD) for portal hypertension of different etiologies including non-cirrhotic portal hypertension have yet to be reported. The data are important to determine the indications and contraindications for this procedure.
  
  
  METHODS
  Records of 54 patients of esophagogastric varices who survived 3 years or longer after DSRS with SPGD operation were reviewed. Patients were divided into three groups based on underlying liver disease; posthepatitic cirrhosis (HC) group, alcoholic cirrhosis (AC) group, and idiopathic portal hypertension (IPH) group.
  
  
  RESULTS
  The only serious long-term complication of DSRS with SPGD was portal thrombosis in two patients in the IPH group. Postoperative bleeding occurred in two cases of each group; one in IPH group was the only variceal bleeding and others were bleeding from portal hypertensive gastropathy. Hepatocellular carcinoma (HCC) was developed in 28.6% patients in both the HC group and AC group. In all the cases, treatment for HCC was accomplished without aggravation of the varices. The cumulative survival rate was similar in the three groups, and no patient died of gastrointestinal bleeding.
  
  
  CONCLUSIONS
  A favorable outcome was achieved by DSRS with SPGD operation both in the patients with cirrhosis or IPH. Underlying liver disease is not a factor when considering DSRS with SPGD for portal hypertension.
authors.affiliation: Department of Surgical Oncology, Division of Cancer Medicine Hokkaido University Graduate School of Medicine, Sapporo, Japan. satto@med.hokudai.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Ambo
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Morikawa
authors.forename: Shunichi
authors.initials: S
authors.lastname: Okushiba
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Katoh
mesh_terms: D004210:Dissection; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013162:Splenic Vein / Q000601:surgery*; D013164:Splenorenal Shunt, Surgical; D013270:Stomach / Q000098:blood supply* / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome