학술논문
Abdominal surgery in patients with chronic noncirrhotic extrahepatic portal vein obstruction: A multicenter retrospective study.
Document Type
Academic Journal
Author
Elkrief L; Faculté de médecine et service d'hépato-gastroentérologie, CHRU de Tours, ERN RARE-LIVER, France.; Inserm, Centre de recherche sur l'inflammation, UMR, Paris, France.; Denecheau-Girard C; Faculté de médecine et service d'hépato-gastroentérologie, CHRU de Tours, ERN RARE-LIVER, France.; Magaz M; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Departament de Medicina i Ciències de la Salut, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Universitat de Barcelona.; Praktiknjo M; Department of Medicine B, University Hospital Münster, Münster, Germany.; Colucci N; Service de chirurgie viscérale, Hôpitaux Universitaires de Genève, Geneva, Switzerland.; Ollivier-Hourmand I; Service d'hépato-gastroentérologie, CHU de Caen, ERN RARE-LIVER, France.; Dumortier J; Service d'Hépatogastroentérologie, Hôpital Edouard Herriot, Lyon.; Simon Talero M; Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain.; Tellez L; Departamento de Gastroenterología y Hepatología Hospital Universitario Ramon y Cajal, Madrid, Spain.; Artru F; Service d'hépato-gastroentérologie, CHUV, Lausanne, Switzerland.; Meszaros M; Service d'Hépato-gastroentérologie, CHU de Montpellier, France.; Verhelst X; Department of Gastroenterology and Hepatology, Ghent University Hospital, Belgium.; Tabchouri N; Service de chirurgie digestive et de transplantation hépatique, CHRU de Tours, France.; Beires F; AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France.; Andaluz I; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Departament de Medicina i Ciències de la Salut, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Universitat de Barcelona.; Leo M; AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France.; Diekhöner M; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.; Dokmak S; AP-HP, Service de chirurgie hépato-biliaire et pancréatique, Hôpital Beaujon, DMU DIGEST, Clichy, France.; Fundora Y; Department of General & Digestive Surgery, Institut de Malalties Digestives I Metabòliques, Hospital Clínic, University of Barcelona, IDIBAPS, Spain.; Vidal-Gonzalez J; Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain.; Toso C; Service de chirurgie viscérale, Hôpitaux Universitaires de Genève, Geneva, Switzerland.; Plessier A; Inserm, Centre de recherche sur l'inflammation, UMR, Paris, France.; AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France.; Carlos Garcia Pagan J; Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Departament de Medicina i Ciències de la Salut, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Universitat de Barcelona.; Rautou PE; Inserm, Centre de recherche sur l'inflammation, UMR, Paris, France.; AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France.
Source
Publisher: Wolters Kluwer Health, Inc Country of Publication: United States NLM ID: 8302946 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3350 (Electronic) Linking ISSN: 02709139 NLM ISO Abbreviation: Hepatology Subsets: MEDLINE
Subject
Language
English
Abstract
Background and Aims: In patients with noncirrhotic chronic extrahepatic portal vein obstruction (EHPVO), data on the morbimortality of abdominal surgery are scarce.
Approach and Results: We retrospectively analyzed the charts of 76 patients (78 interventions) with EHPVO undergoing abdominal surgery within the Vascular Disease Interest Group network. Fourteen percent of the patients had ≥1 major bleeding (unrelated to portal hypertension) and 21% had ≥1 Dindo-Clavien grade ≥3 postoperative complications within 1 month after surgery. Fifteen percent had ≥1 portal hypertension-related complication within 3 months after surgery. Three patients died within 12 months after surgery. An unfavorable outcome (ie, ≥1 abovementioned complication or death) occurred in 37% of the patients and was associated with a history of ascites and with nonwall, noncholecystectomy surgical intervention: 17% of the patients with none of these features had an unfavorable outcome, versus 48% and 100% when one or both features were present, respectively. We then compared 63/76 patients with EHPVO with 126 matched (2:1) control patients without EHPVO but with similar surgical interventions. As compared with control patients, the incidence of major bleeding ( p <0.001) and portal hypertension-related complication ( p <0.001) was significantly higher in patients with EHPVO, but not that of grade ≥3 postoperative complications nor of death. The incidence of unfavorable postoperative outcomes was significantly higher in patients with EHPVO than in those without (33% vs. 18%, p =0.01).
Conclusions: Patients with EHPVO are at high risk of major perioperative or postoperative bleeding and postoperative complications, especially in those with ascites or undergoing surgery other than wall surgery or cholecystectomy.
(Copyright © 2024 American Association for the Study of Liver Diseases.)
Approach and Results: We retrospectively analyzed the charts of 76 patients (78 interventions) with EHPVO undergoing abdominal surgery within the Vascular Disease Interest Group network. Fourteen percent of the patients had ≥1 major bleeding (unrelated to portal hypertension) and 21% had ≥1 Dindo-Clavien grade ≥3 postoperative complications within 1 month after surgery. Fifteen percent had ≥1 portal hypertension-related complication within 3 months after surgery. Three patients died within 12 months after surgery. An unfavorable outcome (ie, ≥1 abovementioned complication or death) occurred in 37% of the patients and was associated with a history of ascites and with nonwall, noncholecystectomy surgical intervention: 17% of the patients with none of these features had an unfavorable outcome, versus 48% and 100% when one or both features were present, respectively. We then compared 63/76 patients with EHPVO with 126 matched (2:1) control patients without EHPVO but with similar surgical interventions. As compared with control patients, the incidence of major bleeding ( p <0.001) and portal hypertension-related complication ( p <0.001) was significantly higher in patients with EHPVO, but not that of grade ≥3 postoperative complications nor of death. The incidence of unfavorable postoperative outcomes was significantly higher in patients with EHPVO than in those without (33% vs. 18%, p =0.01).
Conclusions: Patients with EHPVO are at high risk of major perioperative or postoperative bleeding and postoperative complications, especially in those with ascites or undergoing surgery other than wall surgery or cholecystectomy.
(Copyright © 2024 American Association for the Study of Liver Diseases.)