title: Laparoscopic azygoportal disconnection procedure with a bipolar feedback controlled sealing system in a porcine model.
abstract: BACKGROUND
  To examine the feasibility of a new, minimally invasive procedure for the devascularization of the proximal stomach and distal esophagus to prevent recurrent variceal bleeding in portal hypertension in a new animal model.
  
  
  METHODS
  Portal hypertension was created by laparoscopic clip ligation of the portal vein on 20 pigs. After 2 weeks the azygoportal disconnection procedure was performed with the LigaSure-ATLAS instrument.
  
  
  RESULTS
  There were 16 pigs out of 20 that survived both operations. Two died during introduction of anesthesia, one because of a cardiac arrest (second operation). One pig died resulting from necrosis of the gastric and esophageal wall. Autopsy (2 weeks later) showed that there was a complete arterial devascularization. At autopsy, none of the remaining 16 pigs had esophageal varices or necrosis of the stomach or esophagus.
  
  
  CONCLUSIONS
  Laparoscopic azygoportal disconnection is a less invasive method for the prevention of rebleeding and seems to be safely performed with the LigaSure-ATLAS instrument.
authors.affiliation: Ludwig Boltzmann Research Institute for Operative Laparoscopy and 2nd Surgical Department, Academic Teaching Hospital, Linz, Austria. andreas.Shamiyeh@aon.at
authors.forename: A
authors.initials: A
authors.lastname: Shamiyeh
authors.forename: R
authors.initials: R
authors.lastname: Hubmann
authors.forename: L
authors.initials: L
authors.lastname: Benkö
authors.forename: P
authors.initials: P
authors.lastname: Vattay
authors.forename: E
authors.initials: E
authors.lastname: Röth
authors.forename: L
authors.initials: L
authors.lastname: Tulipan
authors.forename: W U
authors.initials: WU
authors.lastname: Wayand
authors.forename: J
authors.initials: J
authors.lastname: Danis
mesh_terms: D000818:Animals; D001401:Azygos Vein / Q000601:surgery*; D004195:Disease Models, Animal; D004932:Esophageal and Gastric Varices / Q000517:prevention & control / Q000601:surgery*; D004947:Esophagus / Q000098:blood supply; D006975:Hypertension, Portal / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011169:Portal Vein / Q000601:surgery*; D011312:Pressure; D055502:Secondary Prevention; D013270:Stomach / Q000098:blood supply; D013525:Surgical Instruments; D034421:Sus scrofa; D013536:Suture Techniques / Q000295:instrumentation