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The following is a summary of the study “Independent prognostic value of perioperative hepatic venous pressure gradient measurements in patients with portal hypertension who underwent laparoscopic splenectomy plus esophagogastric devascularization,” published in the October 2024 issue of BMC Gastroenterology by Zhang et al.

Portal hypertension (PHT) is a serious complication of liver disease, and hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing its severity. Laparoscopic splenectomy combined with esophagogastric devascularization (LSED) is a key surgical procedure for managing PHT. 

For this study, researchers sought to investigate the prognostic significance of HVPG in patients undergoing LSED and explore postoperative changes in HVPG. They retrospectively evaluated 135 patients who underwent LSED between January 2016 and March 2023. Among them, 57 patients had their HVPG remeasured postoperatively. The study analyzed correlations between clinical indicators, upper gastrointestinal bleeding (UGIB) history, and HVPG before and after surgery.

Patients with a history of UGIB had a higher baseline HVPG (16.27 ± 5.73 mmHg) compared to those without UGIB (14.02 ± 5.90 mmHg, p = 0.04). Postoperative HVPG levels decreased significantly, with a mean reduction of -3.57 ± 8.09 mmHg (p = 0.001), and 66% of patients experienced a substantial HVPG response post-surgery. 

Factors associated with a greater HVPG reduction included a higher baseline HVPG and preoperative Child-Turcotte-Pugh (CTP) class B status (p<0.05). Patients whose postoperative HVPG decreased by more than 20% from baseline had significantly better UGIB-free survival rates compared to those with less reduction (p = 0.013).

The study concluded that LSED significantly reduces HVPG, and patients with greater HVPG reductions after surgery experience better outcomes in terms of preventing recurrent UGIB. These findings highlight the importance of HVPG as an independent prognostic tool in managing portal hypertension.

Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-024-03464-9