It is an easier procedure compared to portosystemic shunting surgery, which requires the specific surgical expertise of vascular anastomosis.40 Therefore, it is generally accepted that every surgeon who is an expert in the field of abdominal surgery can perform Hassab’s operation, without a need for specific surgical skills in vascular surgery. An additional advantage splenectomy
is recovery to the normal range of thrombocyte count from thrombocytopenia, which is caused by hypersplenism following portal hypertension.40,41 However, surgery is limited to patients who can tolerate general anesthesia. A major complication is portal vein thrombosis, but this is easily controlled by postoperative MAPK inhibitor anticoagulation therapy in association with regular ultrasonography to detect the portal thrombosis. find more As a minimally invasive surgery, a laparoscopic devascularizaion of the upper stomach with splenectomy has been successfully performed.42,43 Splenectomy was not previously recommended in younger patients because of overwhelming postsplenectomy infection (OPSI), a potentially rapidly fatal septicemia. However, surgical technology and vaccination, for example (against pneumococcus), has recently developed to the extent that these problems44 are now largely resolved. The non-re-bleeding rate of 100% over 5-year follow up shows this operation could be
the best reliable and promising procedure of a salvage therapy for uncontrolled gastric variceal bleeding. Balloon-occluded retrograde transvenous
obliteration (B-RTO) have been developed and been established as a superior effective treatment for fundic gastric varices and hepatic encephalopathy18 in Japan. A catheter for B-RTO (6.5 French, Create Medic, Tokyo, Japan) is introduced into the gastro-renal shunt via the right femoral vein. While the gastro-renal shunt 上海皓元 of the outflow vessel of the gastric varices is occluded with a balloon, 10 to 20 mL of a 5% solution of ethanolamine olate with iopamidol (EOI) is injected into the gastric varices until their whole length had been visualized (Fig. 4a,b). Gastric varices usually disappear after 2 or 3 months (Fig. 4c). The long-term effectiveness of B-RTO for the treatment of risky gastric varices has been reported.13–15 In most reports, however, the indication for the B-RTO was prophylactic or elective cases, not acute bleeding. There are few reports about the efficacy of B-RTO for the treatment of patients with gastric variceal bleeding. So far as the authors are aware, there are four reports indicating the effectiveness of B-RTO as a secondary prophylaxis for gastric variceal bleeding (Table 2).15,45,46 According to these reports, the rate of re-bleeding from isolated fundic gastric varices is extremely low by B-RTO compared with that by a previous endoscopic treatment with cyanoacryl, over the longer term.