METHOD FOR LAPAROSCOPIC DISTAL SPLENORENAL ANASTOMOSIS WITH SPLENIC ARTERY TYING AND STOMACH DEVASCULARIZATION IN CASE OF PORTAL HYPERTENSION

摘要

FIELD: medicine.;SUBSTANCE: laparoscopic selective portocaval shunt is applied to relieve portal blood flow at liver cirrhosis with subcompensated portal hypertension syndrome. The stomach is mobilized along the large curvature with clipping and intersection of the gastro-omental vein and its tributaries. The mobilized stomach is moved and sutured to the anterior abdominal wall until the pancreas capsule is opened all over it. The splenic-colic ligament is crossed and the splenic flexure of the colon is mobilized. The splenic vein is isolated from the place of confluence with the superior mesenteric vein to the spleen gates. First, the lower and the back surfaces of the vein are prepared. In the area of confluence with the superior mesenteric vein, the splenic vein is circumambulated and cut off using a linear stapler. The front and upper surfaces of the vein are isolated. The pancreatic branches of the splenic vein are clipped. After renal vein mobilization, an anastomosis is formed. If the left adrenal gland or left testicular veins enter the renal vein, they are tied and crossed prior to anastomosis imposition.;EFFECT: method provides limited decompression of venous collaterals in the stomach and lower third of the esophagus, prevention of recurrences of esophageal-gastric bleeding, prevents hepatic insufficiency progression and hepatogenic encephalopathy development in the postoperative period.;2 cl, 5 dwg