Background/aims: Distal splenorenal shunt with splenopancreatic disconnection (DSRS + SPD) evolved to prevent the development of a pancreatic siphon, to improve maintenance as well as quality of portal perfusion and to achieve better long-term survival. We report several cases of postoperative pancreatitis in DSRS + SPD. Recently, oxygen-derived free radicals have been reported to play an important role in pathogenesis of acute pancreatitis.
Methodology: In this study, ten cases of DSRS + SPD were examined intraoperatively. The local changes in oxygen-derived free radicals were obtained by measuring lipid peroxide and an endogenous scavenger (SOD) in the development of DSRS + SPD-induced pancreatitis.
Results: Lipid peroxide activity as the offense system was not changed before or after SPD. However, SOD activity as a defense system was significantly lowered after SPD compared to before SPD.
Conclusions: These results indicate that an imbalance of both systems might be the cause of postoperative pancreatitis.
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Hepatol Res
October 2009
Department of Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
A number of surgical procedures have been developed to manage esophageal varices. Broadly, these can be classified as shunting and non-shunting procedures. While total shunt effectively reduces the incidence of variceal bleeding, it is associated with a high risk of hepatic encephalopathy.
View Article and Find Full Text PDFHepatogastroenterology
July 2005
Department of Surgery, Kinki University School of Medicine, Osaka, Japan.
Background/aims: The Warren-Zeppa distal selective splenorenal shunt (DSRS) is aimed at decompressing esophageal varices by a distal splenorenal shunt, at the same time ligaturing left gastric, gastroepiploic and umbilical veins. In the long-term follow-up the loss of shunt selectivity was observed in several cases. Therefore, Inokuti and Warren reported splenopancreatic disconnection (SPD) to prevent splenic collaterals from stealing portal venous blood.
View Article and Find Full Text PDFSurg Today
October 2002
Cancer Medicine, Surgical Oncology, Division of Cancer Medicine, Hokkaido University Graduate School of Medicine, N15 W7 Kita-ku, Sapporo 060-8638, Japan.
We describe the case of a patient with gastric cancer complicated by portal hypertension due to liver cirrhosis. Endoscopy showed esophageal varices in the lower third of the esophagus and a superficially depressed lesion in the middle third of the stomach, while a biopsy suggested signet-ring cell carcinoma. Laboratory data showed pancytopenia, the indocyanine green fraction after 15 min was 29%, and the symptoms corresponded to the Child B criteria.
View Article and Find Full Text PDFHepatogastroenterology
January 2002
Kinki University, School of Medicine, Second Department of Surgery, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka 589-0014, Japan.
Background/aims: Distal splenorenal shunt with splenopancreatic disconnection (DSRS + SPD) evolved to prevent the development of a pancreatic siphon, to improve maintenance as well as quality of portal perfusion and to achieve better long-term survival. We report several cases of postoperative pancreatitis in DSRS + SPD. Recently, oxygen-derived free radicals have been reported to play an important role in pathogenesis of acute pancreatitis.
View Article and Find Full Text PDFSurgery
September 1999
Second Department of Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Background: Distal splenorenal shunt (DSRS) with splenopancreatic disconnection (SPD) is an ideal operation for permanent control of variceal bleeding. However, it is a very complicated procedure, and DSRS without SPD has a functional disadvantage: It gradually loses its selectivity and portal blood flow. To overcome these conditions, we designed a new technique--modified DSRS, which is easy to perform and maintains long-term selectivity of the shunt.
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