Clinical factors that influence the outcome of selective devascularization in the treatment of portal hypertension

// Cheng-Lin Lu 1 , Ya-Juan Cao 1 , Hao Cheng 1 , Yi-Ming Pan 1 , Shan-Hua Bao 1 , Min Xie 1 1 Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China Correspondence to: Shan-Hua Bao, email: baoshanhua@126.com Min Xie, email: M-xie0828@medmail.com.cn Keywords: selective devascularization, variceal hemorrhage, portal hypertension, clinical factors Received: March 09, 2016      Accepted: April 27, 2016      Published: May 26, 2016 ABSTRACT There is a high incidence of death due to variceal hemorrhage in patients with portal hypertension. Factors to consider when choosing selective devascularization in the treatment of variceal hemorrhage remain a controversy. This study aims to generate the prevalent clinical risk factors that affect the outcomes of selective devascularization procedures. Elucidating these features may guide future treatment of esophageal varices in patients with portal hypertension. We retrospectively analyzed medical records of 455 patients who underwent selective devascularization procedures in our center. Patients were subject to splenectomy, selective devascularization with or without esophageal transection. The mode of surgery recurred in comparable rates in both the group with major complications postoperatively (high-risk group which consisted of 63 patients) or the group without major postoperative complications (low-risk group, 392). Risk factors that negatively influenced outcomes of surgery include severe symptoms (89% in high risk group and 71% in low risk group), large volume of blood loss in the hemorrhage before surgery (81% in high risk group and 16% in low risk group), sever liver cirrhosis (83% in high risk group and 67% in low risk group), previous endotherapy, prolonged prothrombin time, and poor liver function. Selective devascularization is a feasible option to treat variceal hemorrhage in patients with portal hypertension.