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Early mobilization and delayed arterial ligation (EMDAL) as a surgical technique for splenectomy and shunt surgery in portal hypertension.
S L, Harilal; Pottakkat, Biju; Raja, Kalayarasan; Gnanasekaran, Senthil.
Afiliación
  • S L H; Department of Surgical Gastroenterology, JIPMER, Puducherry, India.
  • Pottakkat B; Department of Surgical Gastroenterology, JIPMER, Puducherry, India.
  • Raja K; Department of Surgical Gastroenterology, JIPMER, Puducherry, India.
  • Gnanasekaran S; Department of Surgical Gastroenterology, JIPMER, Puducherry, India.
Ann Hepatobiliary Pancreat Surg ; 28(1): 48-52, 2024 Feb 29.
Article en En | MEDLINE | ID: mdl-38178692
ABSTRACT
Backgrounds/

Aims:

Splenectomy is the most frequently performed procedure as definitive management or as part of shunt surgery or devascularization in portal hypertension. Splenectomy is technically challenging because of the frequent coexistence of multiple collateral varices, splenomegaly, poor liver function, and thrombocytopenia. Early arterial ligation and late mobilization (EALDEM) is the traditional method for splenectomy in portal hypertension. Early spleen mobilization offers good control of the hilum. We aim to compare the effect of the early mobilization and delayed arterial ligation (EMDAL) technique with that of the conventional splenectomy technique in patients with portal hypertension.

Methods:

During the study period from September 2011 to September 2022, 173 patients underwent surgical intervention for portal hypertension at our institution. Among these patients, 114 underwent the conventional method of splenectomy (early arterial ligation and late splenic mobilization) while 59 underwent splenectomy with the EMDAL technique. Demographics were compared between the two groups. Intraoperative and postoperative outcomes were analyzed using the Mann-Whitney test in each group. A minimum follow-up of 12 months was performed in each group.

Results:

Demographics and type of surgical procedure were comparable in the two surgical method groups. Median blood loss was higher in the conventional group than in the EMDAL method. The median duration of surgery was comparable in the two surgical procedures. Clavien-Dindo grade III/IV complications were reported more frequently in the conventional group.

Conclusions:

The splenic hilum can be controlled well and bleeding can be minimised with early mobilization and delayed arterial ligation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Ann Hepatobiliary Pancreat Surg Año: 2024 Tipo del documento: Article País de afiliación: India Pais de publicación: Corea del Sur
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Ann Hepatobiliary Pancreat Surg Año: 2024 Tipo del documento: Article País de afiliación: India Pais de publicación: Corea del Sur