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Vasconcellos LDS, Resende V, Rodrigues JBSR, Petroianu A. Portal thrombosis after surgical treatment of schistosomatic portal hypertension. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231689. [PMID: 39045958 PMCID: PMC11288273 DOI: 10.1590/1806-9282.20231689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Several studies have investigated the correlation between the effects of different surgical treatments and laboratory exams for schistosomal portal hypertension, especially concerning portal system thrombosis. The etiopathogenic factors of this thrombosis are not fully understood. In this study, the correlation between surgical treatment for schistosomal portal hypertension and the occurrence of postoperative portal system thrombosis was investigated. METHODS A total of 61 patients who underwent surgical treatment for schistosomal portal hypertension were distributed into four groups: Patients in Group 1 (n=12) underwent portal variceal disconnection associated with splenic artery ligation and spleen preservation. Patients in Group 2 (n=20) underwent portal variceal disconnection and total splenectomy. Patients in Group 3 (n=20) underwent portal variceal disconnection with subtotal splenectomy, preserving the upper splenic pole supplied by the splenogastric vessels. Patients in Group 4 (n=9) underwent portal variceal disconnection with total splenectomy and autogenous splenic implants on the greater omentum. Late postoperative portal vein thrombosis was diagnosed using Doppler ultrasound. RESULTS Over the 10-year follow-up, portal vein thrombosis occurred in 26 operated patients (42.6%), with no significant difference observed among the four surgical groups (p=0.217). Most of the thrombi only partially occluded the portal system veins. All the patients presented with a thrombus inside the portal vein. There was no difference in hematological and biochemical tests between groups with or without portal vein thrombosis. CONCLUSIONS Portal vein thrombosis is often observed in the late postoperative period, irrespective of the surgical treatment employed, and is not associated with patient characteristics or any hematological and biochemical tests.
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Affiliation(s)
| | - Vivian Resende
- Universidade Federal de Minas Gerais, School of Medicine – Belo Horizonte (MG), Brazil
| | | | - Andy Petroianu
- Universidade Federal de Minas Gerais, School of Medicine – Belo Horizonte (MG), Brazil
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Wang D, Chen X, Lv L, Yang T, Huang B, Cao Y, Lu J, Yin J. The Early Initiation of Perioperative Anticoagulation Therapy in Cirrhotic Patients with Portal Hypertension After Laparoscopic Splenectomy Plus Esophagogastric Devascularization: A 10-Year Single-Center Experience. J Laparoendosc Adv Surg Tech A 2023; 33:1064-1073. [PMID: 37847236 DOI: 10.1089/lap.2023.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Background: Portal veinous system thrombosis (PVST) is a common complication after laparoscopic splenectomy plus esophagogastric devascularization (LSED). Anticoagulation therapy was still in debate in LSED perioperation. This study aimed to determine the postoperative risk factors of PVST, the efficacy and safety of the anticoagulation therapy after LSED procedure, and the potential impact of anticoagulation on patients' liver function and overall survival (OS). Methods: Three hundred patients who underwent LSED were retrospectively enrolled and analyzed in the study. The characteristics of patients, perioperative parameters, risk of PVST, and long-term follow-up data were recorded and analyzed. Results: One hundred eighty six of 300 patients received perioperative anticoagulation therapy (p-AT) postoperation, while 114 patients did not receive p-AT (non-p-AT). The non-p-AT group had more intraoperative blood loss, PVST, longer abdominal drain days, and postoperative hospital stays separately compared with the p-AT group. No significant difference of postoperative complications was found between the two groups. In the 1-year follow-up postoperation, both groups had great improvement in hypersplenism and the portal vein hemodynamics. During the 10-year follow-up period, the incidence of PVST was significantly higher in the non-p-AT group than in the p-AT group. Anticoagulation therapy, sex, variceal hemorrhage history, portal vein diameter, and portal vein velocity were the independent prognostic factors determined by the Cox regression analysis for PVST. The thrombosis-free survival rate (P = .002), recurrent hemorrhage-free survival rate (P < .01), and the OS rate (P < .01) were significantly lower in the non-p-AT group than in the p-AT group. Conclusions: The initiate use of anticoagulation therapy in postoperation of LSED is effective and safe in cirrhotic patients. The anticoagulation therapy after LSED will help decrease portal vein thrombosis, the rebleeding rate, and extend the OS of the patients, especially among women, with variceal hemorrhage history, high portal vein diameter, and low portal vein velocity.
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Affiliation(s)
- Dong Wang
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiao Chen
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ling Lv
- Department of Disease Prevention and Health Care, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tao Yang
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Bo Huang
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yanlong Cao
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianguo Lu
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jikai Yin
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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Darce GFB, Makdissi FF, Ando SDM, Fonseca GM, Kruger JAP, Coelho FF, Rocha MDS, Herman P. HEPATOSPLENIC SCHISTOSOMIASIS-ASSOCIATED CHRONIC PORTAL VEIN THROMBOSIS: RISK FACTOR FOR HEPATOCELLULAR CARCINOMA? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1763. [PMID: 37729278 PMCID: PMC10510374 DOI: 10.1590/0102-672020230045e1763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/20/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Hepatosplenic schistosomiasis is an endemic disease prevalent in tropical countries and is associated with a high incidence of portal vein thrombosis. Inflammatory changes caused by both parasitic infection and portal thrombosis can lead to the development of chronic liver disease with potential carcinogenesis. AIMS To assess the incidence of portal vein thrombosis and hepatocellular carcinoma in patients with schistosomiasis during long-term follow-up. METHODS A retrospective study was conducted involving patients with schistosomiasis followed up at our institution between 1990 and 2021. RESULTS A total of 126 patients with schistosomiasis were evaluated in the study. The mean follow-up time was 16 years (range 5-31). Of the total, 73 (57.9%) patients presented portal vein thrombosis during follow-up. Six (8.1%) of them were diagnosed with hepatocellular carcinoma, all with portal vein thrombosis diagnosed more than ten years before. CONCLUSIONS The incidence of hepatocellular carcinoma in patients with schistosomiasis and chronic portal vein thrombosis highlights the importance of a systematic long-term follow-up in this group of patients.
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Affiliation(s)
| | - Fabio Ferrari Makdissi
- Universidade de São Paulo, Faculty of Medicine, Cancer Institute – São Paulo (SP), Brazil
| | - Sabrina de Mello Ando
- Universidade de São Paulo, Falculty of Medicine, Department of Radiology –São Paulo (SP), Brazil
| | - Gilton Marques Fonseca
- Universidade de São Paulo, Falculty of Medicine, Department of Gastroenterology – São Paulo (SP), Brazil
| | | | - Fabricio Ferreira Coelho
- Universidade de São Paulo, Falculty of Medicine, Department of Gastroenterology – São Paulo (SP), Brazil
| | - Manoel de Souza Rocha
- Universidade de São Paulo, Falculty of Medicine, Department of Radiology –São Paulo (SP), Brazil
| | - Paulo Herman
- Universidade de São Paulo, Falculty of Medicine, Department of Gastroenterology – São Paulo (SP), Brazil
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de Abreu ES, Nardelli MJ, Lima AMC, Cardoso JB, Osório FMF, Ferrari TCDA, Faria LC, Couto CA, Cançado GGL. Carvedilol as secondary prophylaxis for variceal bleeding in hepatosplenic schistosomiasis. Trans R Soc Trop Med Hyg 2022; 116:663-667. [DOI: 10.1093/trstmh/trab190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/24/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Upper variceal bleeding (UVB) is a possible complication of portal hypertension secondary to hepatosplenic schistosomiasis (HSS). Propranolol is a non-selective beta-blocker used as secondary prophylaxis for UVB, but no previous studies have addressed carvedilol effects in rebleeding prevention.
Methods
A retrospective exploratory study of 57 patients with chronic HSS and index UVB treated with endoscopic variceal ligation and propranolol or carvedilol was conducted. The primary outcome was UVB-free time in the first 12 mo after the initial bleeding episode.
Results
Propranolol was used for secondary UVB prophylaxis in 43 (75.4%) participants (median dose 80 [interquartile range – IQR 60–80] mg/d) and carvedilol in 14 (24.6%) participants (median dose 12.5 [IQR 7.9–25.0] mg/d). During a 12-mo follow-up, rebleeding was observed in 13 (22.8%) patients, 9 (20.9%) of those treated with propranolol and 4 (28.6%) treated with carvedilol (p=0.715). Mean time from the beginning of drug prophylaxis to rebleeding was 6±3 mo and there was no difference between that for propranolol vs carvedilol subgroups. Portal vein thrombosis did not influence the bleeding recurrence in either subgroup.
Conclusion
Carvedilol may be equally effective as propranolol in preventing secondary UVB in HSS at 12-mo follow-up.
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Affiliation(s)
- Eliabe Silva de Abreu
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Mateus Jorge Nardelli
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - André Mourão Costa Lima
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Jaqueline Brito Cardoso
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Fernanda Maria Farage Osório
- Instituto Alfa de Gastroenterologia , Avenida Professor Alfredo Balena, 110-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Teresa Cristina de Abreu Ferrari
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
- Instituto Alfa de Gastroenterologia , Avenida Professor Alfredo Balena, 110-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Luciana Costa Faria
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
- Instituto Alfa de Gastroenterologia , Avenida Professor Alfredo Balena, 110-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Cláudia Alves Couto
- Faculdade de Medicina da Universidade Federal de Minas Gerais , Avenida Professor Alfredo Balena, 190-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
- Instituto Alfa de Gastroenterologia , Avenida Professor Alfredo Balena, 110-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
| | - Guilherme Grossi Lopes Cançado
- Instituto Alfa de Gastroenterologia , Avenida Professor Alfredo Balena, 110-Santa Efigěnia, Belo Horizonte, Minas Gerais 30310-100, Brazil
- Hospital da Polícia Militar de Minas Gerais , Rua Pacífico Mascarenhas, s/n-Santa Efigěnia, Belo Horizonte, Minas Gerais 30110-013, Brazil
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