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Abdominal Surgery in Patients With Idiopathic Noncirrhotic Portal Hypertension: A Multicenter Retrospective Study

Laure ElkriefService d'Hépato‐Gastroentérologie,Hôpitaux Universitaires de Genève,Geneva,SwitzerlandJosé Ferrusquía‐AcostaHepatic Hemodynamic Laboratory, European Reference Network for Rare Liver Disorders, Liver Unit,Hospital Clinic, IDIBAPS and CIBERehd,Barcelona,SpainAudrey PayancéService d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif,Hôpital Beaujon, AP‐HP,Clichy,FranceLucile MogaService d'Hépato‐Gastro‐Entérologie,CHU Toulouse,Toulouse,FranceLuís TéllezDepartamento de Gastroenterología y Hepatología,Hospital Universitario Ramon y Cajal,Madrid,SpainMichael PraktiknjoLaboratory for Liver Fibrosis and Portal Hypertension,Universitatsklinikum,Bonn,GermanyBogdan ProcopețDepartment of Gastroenterology, 3rd Medical Clinic,University of Medicine and Pharmacy “luliu Hatieganu,” Regional Institute of Gastroenterology and Hepatology “O Fodor,”,Cluj‐Napoca,RomaniaOana Nicoară-FarcăuDepartment of Gastroenterology, 3rd Medical Clinic,University of Medicine and Pharmacy “luliu Hatieganu,” Regional Institute of Gastroenterology and Hepatology “O Fodor,”,Cluj‐Napoca,RomaniaVictor de LédinghenService d'Hépato‐Gastroentérologie,Hôpital Haut‐Lévêque,Bordeaux,FranceR. Z. YuldashevRepublican Specialized Scientific Practical Medical Center of Pediatrics,Tashkent,UzbekistanNicolas TabchouriService de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique et FHU SUPORT,Hôpital Trousseau,Tours,FranceLouise BarbierService de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique et FHU SUPORT,Hôpital Trousseau,Tours,FranceJérôme DumortierDepartment of Digestive Diseases, Hospices Civils de Lyon,Hôpital Edouard Herriot, Université Claude Bernard Lyon 1,Lyon,FranceBenjamin MenahemDepartment of Digestive Surgery,University Hospital of Caen,Caen,FranceMarta MagazHepatic Hemodynamic Laboratory, European Reference Network for Rare Liver Disorders, Liver Unit,Hospital Clinic, IDIBAPS and CIBERehd,Barcelona,SpainVirginia Hernández–GeaHepatic Hemodynamic Laboratory, European Reference Network for Rare Liver Disorders, Liver Unit,Hospital Clinic, IDIBAPS and CIBERehd,Barcelona,SpainAgustı́n AlbillosDepartamento de Gastroenterología y Hepatología,Hospital Universitario Ramon y Cajal,Madrid,SpainJonel TrebickaLaboratory for Liver Fibrosis and Portal Hypertension,Universitatsklinikum,Bonn,GermanyLaurent SpahrService d'Hépato‐Gastroentérologie,Hôpitaux Universitaires de Genève,Geneva,SwitzerlandAndrea De GottardiAurélie PlessierService d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif,Hôpital Beaujon, AP‐HP,Clichy,FranceDominique VallaService d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif,Hôpital Beaujon, AP‐HP,Clichy,FranceLaura Rubbia‐BrandtService de pathologie Clinique,Hôpitaux Universitaires de Genève,Geneva,SwitzerlandChristian TosoService de Chirurgie viscérale,Hôpitaux Universitaires de Genève,Geneva,SwitzerlandChristophe BureauService d'Hépato‐Gastro‐Entérologie,CHU Toulouse,Toulouse,FranceJuan Carlos García‐PagánHepatic Hemodynamic Laboratory, European Reference Network for Rare Liver Disorders, Liver Unit,Hospital Clinic, IDIBAPS and CIBERehd,Barcelona,SpainPierre‐Emmanuel RautouInserm, UMR 970,Paris Cardiovascular Research Center–PARCC,Paris,France

Hepatologyjournal2019en

ABI

Аннотация

In patients with idiopathic noncirrhotic portal hypertension (INCPH), data on morbidity and mortality of abdominal surgery are scarce. We retrospectively analyzed the charts of patients with INCPH undergoing abdominal surgery within the Vascular Liver Disease Interest Group network. Forty-four patients with biopsy-proven INCPH were included. Twenty-five (57%) patients had one or more extrahepatic conditions related to INCPH, and 16 (36%) had a history of ascites. Forty-five procedures were performed, including 30 that were minor and 15 major. Nine (20%) patients had one or more Dindo-Clavien grade ≥ 3 complication within 1 month after surgery. Sixteen (33%) patients had one or more portal hypertension-related complication within 3 months after surgery. Extrahepatic conditions related to INCPH (P = 0.03) and history of ascites (P = 0.02) were associated with portal hypertension-related complications within 3 months after surgery. Splenectomy was associated with development of portal vein thrombosis after surgery (P = 0.01). Four (9%) patients died within 6 months after surgery. Six-month cumulative risk of death was higher in patients with serum creatinine ≥ 100 μmol/L at surgery (33% versus 0%, P < 0.001). An unfavorable outcome (i.e., either liver or surgical complication or death) occurred in 22 (50%) patients and was associated with the presence of extrahepatic conditions related to INCPH, history of ascites, and serum creatinine ≥ 100 μmol/L: 5% of the patients with none of these features had an unfavorable outcome versus 32% and 64% when one or two or more features were present, respectively. Portal decompression procedures prior to surgery (n = 10) were not associated with postoperative outcome. Conclusion: Patients with INCPH are at high risk of major surgical and portal hypertension-related complications when they harbor extrahepatic conditions related to INCPH, history of ascites, or increased serum creatinine.

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Мавзулар

Liver Disease and Transplantation Abdominal vascular conditions and treatments Liver Disease Diagnosis and Treatment

Идентификаторлар

DOI: 10.1002/hep.30628

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