[Laparoscopic devascularization of the stomach and the abdominal esophagus with the LigaSure instrument in a porcine model].
OBJECTIVE
In this study we proved the feasibility of a new minimally invasive procedure for the devascularisation of the proximal stomach and the abdominal esophagus to prevent recurrent variceal bleeding in portal hypertension in a new animal model.


METHODS
Experiments were performed on 12 female pigs, in two animal groups. In the first step (I. group n=6) portal hypertension was created by controlled laparoscopic clip ligation of the portal vein. The increased portal pressure was established by the needle puncture of the portal vein and the spleen. Two weeks later, the dilated veins were sealed along the lesser and greater curvature and the transhiatal esophagus with the 10 mm LigaSure instrument. Successful of the experimental model had encouraged us to perform this method on other animals (II. group, n=6), using the 5 mm instrument.


RESULTS
There was no intraoperative bleeding after using both LigaSure instruments. Autopsy (2 weeks later) showed correct placed clips with partial occlusion of the portal vein without portal vein thrombosis. There was no evidence of postoperative bleeding. Histological investigation of the gastric surface confirmed complete sealing of the extended varices.


CONCLUSIONS
The laparoscopic LigaSure instrument was found to be safe and suitable equipment for the ligation of the dilated veins along the gastric surface and the abdominal esophagus, and this method could be an alternate choice for the patients with recurrent variceal bleeding.
Benko
László
L
Pécsi TudomBnyegyetem, Altalános Orvostudományi Kar, Sebészeti Oktaó6 és Kutató Intézet. laszlo.benko@aok.pte.hu
Danis
Jan
J
Shamiyeh
Andreas
A
Czompo
Manfred
M
Gasz
Balázs
B
Ferencz
Andrea
A
Jancsó
Gábor
G
Roth
Erzsébet
E
D000818:Animals; D004195:Disease Models, Animal; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D004947:Esophagus / Q000098:blood supply / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology; D010535:Laparoscopy; D017082:Portal Pressure; D013270:Stomach / Q000098:blood supply / Q000601:surgery*; D013552:Swine; D014656:Vascular Surgical Procedures / Q000379:methods*