Laparoscopic azygoportal disconnection procedure with a bipolar feedback controlled sealing system in a porcine model.
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.
Shamiyeh
A
A
Ludwig Boltzmann Research Institute for Operative Laparoscopy and 2nd Surgical Department, Academic Teaching Hospital, Linz, Austria. andreas.Shamiyeh@aon.at
Hubmann
R
R
Benkö
L
L
Vattay
P
P
Röth
E
E
Tulipan
L
L
Wayand
W U
WU
Danis
J
J
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