Beneficial effect of partial portal decompression using the inferior mesenteric vein for intractable gastroesophageal variceal bleeding in patients with liver cirrhosis.
BACKGROUND
Use of the inferior mesenteric vein (IMV) for partial portal decompression has not been recommended as a first-line option for intractable gastroesophageal variceal bleeding because of the thin diameter of the vein. Although these indications remain relevant, few reports have compared partial portal decompression using the IMV with other therapies. We propose that partial portal decompression using the IMV is a useful alternative treatment for intractable variceal bleeding.


METHODS
We performed partial portal decompression using the IMV in eight patients with intractable variceal bleeding that had been uncontrolled using medical and endoscopic therapies. All patients were classified into Child's class B or C. The surgical data, morbidity, and mortality were assessed.


RESULTS
Mean portal venous pressure significantly decreased from 26.9 +/- 2.0 mmHg before the surgery to 19.8 +/- 3.9 mmHg after the surgery. The operative mortality rate was 0%. The mean duration of hospital stay was 25.5 +/- 13.3 days. Although one patient experienced recurrent bleeding, shunt patency was well maintained in all patients during the follow-up period (mean 28.9 +/- 14.1 months). Six patients are still alive and well without ascites or hepatic encephalopathy. Two of the Child's class C patients who underwent emergency shunt died owing to hepatic decompensation.


CONCLUSIONS
Partial portal decompression using the IMV can be a safe, effective way to treat intractable variceal bleeding in patients with liver cirrhosis. However, use of the shunt procedure may have the most survival benefits for cirrhotic patients with preserved liver function.
Yamamoto
Satoshi
S
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. sugarman@med.niigata-u.ac.jp
Sato
Yoshinobu
Y
Nakatsuka
Hideki
H
Oya
Hiroshi
H
Kobayashi
Takashi
T
Hatakeyama
Katsuyoshi
K
D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality; D012008:Recurrence; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014690:Venous Pressure / Q000502:physiology