Surgical treatment of portal hypertension complications in patients with liver cirrhosis
V. M. Durleshter,
S. A. Gabriel,
N. V. Korochanskaya,
D. S. Murashko,
S. N. Serikova,
V. Yu. Dynko,
O. A. Usova,
M. A. Basenko,
A. Yu. Bukhtoyarov https://doi.org/10.35401/2541-9897-2022-25-3-37-42
Abstract
Objective: Improving the results of surgical treatment of portal hypertension complications in patients with liver cirrhosis.
Material and methods: The results of medical care for 328 patients with liver cirrhosis, who were treated in the surgical departments of the central district and city hospitals of the Krasnodar Region, were analyzed. The effectiveness of minimally invasive surgical treatment of portal hypertension complications in 832 patients with liver cirrhosis treated at the Regional Clinical Hospital no. 2 of the Ministry of Health of the Krasnodar Region were also evaluated.
Results: The mortality rate in patients with liver cirrhosis, admitted in first-level institutions of medical care due to acute bleeding from esophageal varices, reached 26.3%. In conditions of surgical treatment of complications of portal hypertension in a third-level institution of specialized care it did not exceed 4.7%.
Conclusion: The optimal approach to the surgical treatment of patients with liver cirrhosis is to stop the bleeding from esophageal varices at the first stage of medical care and to treat portal hypertension complications using minimally invasive technologies in a multidisciplinary clinic involving a multidisciplinary team of doctors.
About the Authors
V. M. Durleshter
Kuban State Medical University; Regional Clinical Hospital no. 2
Russian Federation
Russian Federation
Vladimir M. Durleshter - Dr. Sci. (Med.), Professor, Head of the Department of Surgery no. 3, Kuban State Medical University; Deputy Chief Physician for Surgery, RCH no. 2.
Krasnodar
S. A. Gabriel
Kuban State Medical University; Regional Clinical Hospital no. 2
Russian Federation
Russian Federation
Sergey A. Gabriel - Dr. Sci. (Med.), Chief Physician, RCH no. 2; Professor of the Department of Surgery no. 3, Kuban SMU.
Krasnodar
N. V. Korochanskaya
Kuban State Medical University; Regional Clinical Hospital no. 2
Russian Federation
Russian Federation
Natalya V. Korochanskaya - Dr. Sci. (Med.), Head of the Gastroenterology Centre, RCH no. 2; Professor of the Department of Surgery no. 3, Kuban SMU.
6/2, Krasnykh partisan str., Krasnodar, 350012
D. S. Murashko
Kuban State Medical University; Regional Clinical Hospital no. 2
Russian Federation
Russian Federation
Dmitry S. Murashko - Cand. Sci. (Med.), Surgeon, Surgical Department no. 5, RCH no. 2; Assistant, Department of Surgery no. 3, Kuban SMU.
Krasnodar
S. N. Serikova
Kuban State Medical University; Regional Clinical Hospital no. 2
Russian Federation
Russian Federation
Svetlana N. Serikova, Dr. Sci. (Med.), Head of the Gastroenterology Centre with Specialized Course Outpatient Treatment; Professor of the Department of Surgery no. 3, Kuban SMU.
Krasnodar
V. Yu. Dynko
Kuban State Medical University; Regional Clinical Hospital no. 2
Russian Federation
Russian Federation
Viktor Yu. Dynko - Cand. Sci. (Med.), Head of the Department of Endoscopy, RCH no. 2; Assistant, Department of Surgery no. 3, Kuban SMU
Krasnodar
O. A. Usova
Regional Clinical Hospital no. 2
Russian Federation
Russian Federation
Olga A. Usova - Cand. Sci. (Med.), Gastroenterologist, RCH no. 2.
Krasnodar
M. A. Basenko
Kuban State Medical University
Russian Federation
Russian Federation
Mikhail A. Basenko - Postgraduate student, Department of Surgery no. 3, Kuban SMU.
Krasnodar
A. Yu. Bukhtoyarov
Regional Clinical Hospital no. 2
Russian Federation
Russian Federation
Artem Yu. Bukhtoyarov - Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment no. 2, RCH no. 2.
Krasnodar
References
1. Teh SH, Nagorney DM, Stevens SR, et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology. 2007;132(4):1261–1269. PMID: 17408625. https://doi.org/10.1053/j.gastro.2007.01.040
2. Johnson KM, Newman KL, Green PK, et al. Incidence and risk factors of postoperative mortality and morbidity after elective versus emergent abdominal surgery in a national sample of 8193 patients with cirrhosis. Ann Surg. 2021;274(4):345–354. PMID: 31714310. https://doi.org/10.1097/SLA.0000000000003674
3. Olevskaya ER, Dolgushina AI, Tarasov AN, et al. Prognosis factors of survival in patients with liver cirrhosis and portal hypertension. Therapeutic archive. 2019;91(2):67–72. (In Russ.). http://doi.org/10.26442/00403660.2019.02.000089
4. Maassel NL, Fleming MM, Luo J, et al. Model for end-stage liver disease sodium as a predictor of surgical risk in cirrhotic patients with ascites. J Surg Res. 2020;250:45–52. PMID: 32018142. https://doi.org/10.1016/j.jss.2019.12.037
5. Leeds IL, Canner JK, Gani F, et al. Increased healthcare utilization for medical comorbidities prior to surgery improves postoperative outcomes. Ann Surg. 2020;271(1):114–121. PMID: 29864092. PMCID: PMC8559326. http://doi.org/10.1097/SLA.0000000000002851
6. Zhigalova SB, Manukiyan GV, Shertsinger AG, et al. Prognostic criteria of variceal bleeding in patients with portal hypertension. Annals of HPB Surgery. 2018;23(4):76–85. (In Russ.). https://doi.org/10.16931/1995-5464.2018476-85
7. Anisimov AYu, Vertkin AL, Devyatov AV, et al. Clinic guidelines for the treatment of bleeding from esophageal and gastric varicose veins. Moscow: Voronezh; 2014:45. (In Russ.).
8. Ivashkin VT, Mayevskaya MV, Pavlov CS, et al. Treatment of liver cirrhosis complications: Clinical guidelines of the Russian Scientific Liver Society and Russian gastroenterological association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016;26(4):71–102. (In Russ.). https://doi.org/10.22416/1382-4376-2016-26-4-71-102
9. Bkulin IG, Skalinskaya MI, Maev IV, et al. Pharmacotherapy of inflammatory bowel diseases: efficacy performance and safety management. Therapeutic archive. 2021;93(8):841–852. (In Russ.). http://doi.org/10.26442/00403660.2021.08.200982
10. Durleshter VM, Korochanskaya NV, Gabriel SA, et al. Surgical treatment of liver cirrhosis: a multidisciplinary approach: monograph. Moscow: Practical medicine; 2021:120. (In Russ.).
Review
For citations:
Durleshter V.M., Gabriel S.A., Korochanskaya N.V., Murashko D.S., Serikova S.N., Dynko V.Yu., Usova O.A., Basenko M.A., Bukhtoyarov A.Yu. Surgical treatment of portal hypertension complications in patients with liver cirrhosis. Innovative Medicine of Kuban. 2022;(3):37-42. (In Russ.) https://doi.org/10.35401/2541-9897-2022-25-3-37-42
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