Prevention of recurrent bleeding from varicose veins of the esophagus and stomach among patients with decompensated liver cirrhosis

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Aim. To evaluate the efficiency of laparoscopic devascularization of the esophagus and stomach with endoscopic ligation of varicose esophageal veins in the prevention of esophageal-gastric bleeding among patients with decompensated liver cirrhosis.

Methods. The results of treatment of 73 patients with decompensated liver cirrhosis and high risk of bleeding were analyzed. To prevent recurrent bleeding from esophageal and gastric veins, all patients underwent endoscopic ligation at the first step of treatment. In case of inefficiency of ligation and recurrence of varicose veins of esophagus, laparoscopic devascularization of esophagus and stomach was performed. The efficiency of laparoscopic devascularization with intraoperative endoscopic ligation of varicose esophageal veins and ligation as an independent method of treatment for the prevention of upper gastrointestinal bleeding was estimated by comparison of the frequency of recurrence of esophageal and gastric bleeding and recurrence of esophageal varices according to upper endoscopy in comparison groups.

Results. In 6 months, 1 and 2 years after laparoscopic devascularization of the esophagus and stomach in combination with endoscopic ligation, the risk of bleeding is less compared to endoscopic ligation as an isolated treatment method (p=0.05; p=0.052; p=0.06). Laparoscopic devascularization with ligation reduces the risk of recurrence of esophageal varices during the first year after surgery by 20% (χ2=2.61; p=0.106), in 2 years by 23% (χ2=1.75; p=0.091) compared to endoscopic ligation only.

Conclusion. Patients with liver cirrhosis with decompensated hepatic failure satisfactorily postpone endovideosurgical interventions; laparoscopic gastric devascularization with the intersection of the main inflows to the esophageal varicose veins is an effective method to prevent esophageal-gastric hemorrhage among patients with decompensated liver cirrhosis after ineffective endoscopic ligation.

I E Onnitsev

S.M. Kirov Military Medical Academy

Author for correspondence.
Saint Petersburg, Russia

S A Bugaev

A.V. Vishnevsky Institute of Surgery

Moscow, Russia

S Ya Ivanusa

S.M. Kirov Military Medical Academy

Saint Petersburg, Russia

I I Dzidzava

S.M. Kirov Military Medical Academy

Saint Petersburg, Russia

A V Khokhlov

S.M. Kirov Military Medical Academy

Saint Petersburg, Russia

B N Kotiv

S.M. Kirov Military Medical Academy

Saint Petersburg, Russia

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© 2019 Onnitsev I.E., Bugaev S.A., Ivanusa S.Y., Dzidzava I.I., Khokhlov A.V., Kotiv B.N.

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