A NOVEL TECHNIQUE OF LAPAROSCOPIC MAGNETIC COMPRESSION IN PORTAL-AZYGOUS DEVASCULARIZATION
Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
Background: In patients with liver cirrhosis, increased pressure of portal vein causes large veins to develop across the esophagus and stomach (varices). The varices become fragile, bleed easily and fatal. The treatments include drug hemostasis, endoscopic therapy, devascularization plus splenectomy, etc. In this study, we introduces a novel technique of laparoscopic magnetic compression in portal-azygous devascularization, which has the advantages of simple, minimally invasive, inexpensive, continuous compression force and less postoperative complications.
Methods: The magnets used in the experiment were made of Ti-coated neodymium-iron-boron (Nd-Fe-B), the shape was hollow columnar with sections on two sides. Magnets with basal diameter of 6mm, height of 8mm and center hole diameter is 1mm. In the guidance of the vascular guide wire, magnets can be pushed into the 10mm silica gel drainage tube. In total of 8-10 same shaped magnets can be inserted to form the magnetic drainage tube. The animal model of portal vein stenosis was established in experimental dogs. One month after the operation, portal vein angiography was performed to confirm the varicosity of the lateral branches of the portal-azygos vein. The drainage tube was placed in the space of the lesser omental sac on the dorsal side of the varicose vein. Another tube was placed on the ventral side of the varicose vein, both tubes were extracted from the skin and fixed. Under the guidance of the guide wire, 8-10 prepared magnets were placed into the two drainage tubes, respectively. The dorsal and ventral magnets were attracted under the gravity automatically, the portal-azygous devascularization was completed. Portal vein angiography was performed on the 7-, 10-, 30th day post-operatively. Magnetic drainage tube was removed until the 10th day. Tissue harvest was on the 30th day.
Results: All dogs survived post-operatively, without bleeding, infection, magnet shedding, displacement and other complications. Portal vein angiography showed that the magnetic force was strong enough to block the varices, portal-azygous devascularization was confirmed on the 10th day after the removement of the magnetic drainage tubes. There is no recurrent varices in 30th day post-operatively, then the tissue were harvested, mild necrosis and inflammation response can be observed.
Conclusion: The results fully confirmed that this effective and simple operation could be a novel way for the treatment in the liver cirrhosis patients with portal-azygos varicose.
Sponsorship：2021 Science and technology Talents Support project of Shaanxi Provincial People's Hospital (2021JY-08).
Illustration of magnetic compression portal-azygous devascularization
A. Anatomy of liver, stomach and ligaments, B. The drainage tube A was placed in the back space of varicose vein, C. The drainage tube B was placed on the ventral side of the varicose vein, D. Magnets were pushed into the two tubes, E. Magnetic tube attracted and compressed the varicose vein, F. Necrotic tissue was formed in 10 days, the portal-azygous devascularization was completed.
Laparascopic magnetic compression portal-azygous devascularization
A. Separate hepatogastric ligaments and varicose vein, B. Placed the drainage tube A, C. Placed the drainage tube B, D. Magnets were pushed into the tubes, E. Magnetic force compressed the varicose vein, F. The portal-azygous devascularization was completed.
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