Laparoscopic Partial Closure for Congenital Portosystemic Shunt-Indications, Postoperative Management, and Subsequent Complete Closure

Teizaburo Mori, Yohei Yamada, Kiyotomo Abe, Nobuhiro Takahashi, Motohiro Kano, Takumi Fujimura, Toshihiko Watanabe, Seishi Nakatsuka, Ken Hoshino, Tatsuo Kuroda

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Abstract

Extrahepatic congenital portosystemic shunts (CPSSs) can be occluded by surgical or endovascular approaches. However, when the estimated portal vein (PV) pressure after the closure is high enough to induce symptoms associated with portal hypertension, partial closure is recommended to avoid life-threatening events. In this study, we attempted laparoscopic partial closure of a CPSS in two patients. Along with intraoperative real-time measuring of the PV pressure and angiography, laparoscopic partial closure was performed to achieve a PV pressure of ≤25 mmHg. Subsequently, the intrahepatic portal system grew in both patients. The partially ligated CPSS closed spontaneously in the first patient. In the second patient, laparoscopic complete closure was performed for the residual CPSS 6 months after the first operation. To our knowledge, this is the first report of laparoscopic partial closure for CPSS. Minimally invasive laparoscopic partial ligation of CPSS is technically feasible and useful when the estimated PV pressure is too high to tolerate one-step complete closure.

Original languageEnglish
Pages (from-to)573-578
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume29
Issue number4
DOIs
Publication statusPublished - 2019 Apr 1

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Keywords

  • laparoscopy
  • partial closure
  • portal hypertension
  • portosystemic shunt
  • two-step closure

ASJC Scopus subject areas

  • Surgery

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