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Published Online: 10 April 2019

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

Publication: Journal of Laparoendoscopic & Advanced Surgical Techniques
Volume 29, Issue Number 4

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.

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Information & Authors

Information

Published In

cover image Journal of Laparoendoscopic & Advanced Surgical Techniques
Journal of Laparoendoscopic & Advanced Surgical Techniques
Volume 29Issue Number 4April 2019
Pages: 573 - 578
PubMed: 30614751

History

Published online: 10 April 2019
Published in print: April 2019
Published ahead of print: 7 January 2019

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    Authors

    Affiliations

    Teizaburo Mori, MD
    Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
    Yohei Yamada, MD, PhD [email protected]
    Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
    Kiyotomo Abe, MD
    Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
    Nobuhiro Takahashi, MD
    Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
    Motohiro Kano, MD
    Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
    Takumi Fujimura, MD, PhD
    Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
    Toshihiko Watanabe, MD, PhD
    Department of Pediatric Surgery, Tokai University School of Medicine, Kanagawa, Japan.
    Seishi Nakatsuka, MD, PhD
    Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
    Ken Hoshino, MD, PhD
    Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
    Tatsuo Kuroda, MD, PhD
    Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.

    Notes

    Address correspondence to: Yohei Yamada, MD, PhD, Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo 160-8582, Japan [email protected]

    Disclosure Statement

    No competing financial interests exist.

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