title: Hand-assisted laparoscopic splenectomy and devascularization of the upper stomach in the management of gastric varices.
abstract: BACKGROUND
  Bleeding from esophagogastric varices is the major cause of death in patients with portal hypertension. Although esophageal varices can be treated with endoscopic procedures, the treatment for gastric varices is still controversial. The aim of this study was to describe a surgical technique and our preliminary results of hand-assisted laparoscopic Hassab's procedure.
  
  
  METHODS
  Between February 2002 and May 2005, we performed 7 cases of gastric varices with this type of operation. The patients included 4 men and 3 women who ranged in age from 23 to 74 years (underlying liver disease: 5 case of liver cirrhosis, 1 case of polycystic disease, 1 case of extrahepatic portal vein obstruction). After splenctomy was performed, we devascularized the vessels of the upper stomach and the esophagus 5 cm away from the esophago-cardia junction.
  
  
  RESULTS
  The operative time ranged from 132 to 290 minutes. Intraoperative blood loss was estimated to be from 50 ml to 475 ml. The weight of removed spleen ranged from 110 g to 800 g. During the follow-up period, all gastric varices disappeared and no bleeding from varicose veins was observed. All patients had hypersplenism with thrombocytopenia before surgery (mean: 11.1+/-7.4x10(4)/ml), which was improved postoperatively (mean: 30.8+/-19.0x10(4)/ml). This data were statistically significant (P=0.033). One patient died of aspiration pneumonia related to postoperative pyloric stricture.
  
  
  CONCLUSIONS
  Although there is no agreement concerning the best treatment of gastric varices, the hand-assisted laparoscopic Hassab's operation is a safe, moderately invasive method, and its outcome appears to be equal to that of other open procedures.
authors.affiliation: Department of Surgery, Chibanishi General Hospital, Chiba, Japan. jojiyamamotomd@yahoo.co.jp
authors.forename: Joji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Motoki
authors.initials: M
authors.lastname: Nagai
authors.forename: Barry
authors.initials: B
authors.lastname: Smith
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tamaki
authors.forename: Tadao
authors.initials: T
authors.lastname: Kubota
authors.forename: Ken
authors.initials: K
authors.lastname: Sasaki
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ohmori
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Maeda
mesh_terms: D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013156:Splenectomy / Q000379:methods*; D013270:Stomach / Q000098:blood supply / Q000601:surgery*; D016896:Treatment Outcome