{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:18:11Z","timestamp":1765459091902,"version":"3.46.0"},"reference-count":20,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: To investigate the safety and efficacy of Hassab\u2019s surgery as a salvage treatment for patients with secondary prophylaxis failure for acute variceal bleeding (AVB), and to determine the role of Hassab\u2019s surgery in the recompensation of cirrhosis and nutritional improvement. Methods: This study retrospectively analyzed data of 19 patients with AVB caused by cirrhosis and portal hypertension who underwent Hassab\u2019s surgery as a salvage treatment after secondary prophylaxis failure in our center from March 2018 to June 2021. In addition, 47 patients with esophageal and gastric varices who underwent secondary prophylaxis during the same period were assigned to the control group to assess the safety and efficacy of the surgery. The objective laboratorial index and L3-SMA (the L3 skeletal muscle area, cm2, a radiological index for assessing whole-body skeletal muscle mass via CT measurement at the third lumbar vertebra level) of patients in the experimental group before and after surgery were compared to evaluate re-compensation of cirrhosis and nutritional improvement. Results: There was no significant difference in the incidence of perioperative complications and severe complications (Clavien\u2013Dindo grade \u2265 IIIb) between the experimental group and the control group. The 5-year re-bleeding-free survival rate and the 5-year overall survival rate in the experimental group were 73.7% and 94.7%, respectively, which were not significantly different from those in the control group. In addition, compared with before surgery, the white blood cell count, platelet count, hemoglobin level, model for end-stage liver disease (MELD) score, Child\u2013Pugh grades, prothrombin time (PT), international normalized ratio (INR), and L3-SMA significantly increased in the experimental group after surgery. Conclusions: Hassab\u2019s surgery proves to be a safe and effective salvage treatment for patients with AVB caused by liver cirrhosis and portal hypertension who failed to undergo secondary prophylaxis. Meanwhile, it was found that after surgery, not only were hypersplenism and coagulation abnormalities relieved, but also cirrhosis was compensated and nutritional status was improved significantly. Thus, this study revealed that Hassab\u2019s surgery with safety and long-term survival effects can be used for patients with secondary prophylaxis failure for AVB in eligible patients<\/jats:p>","DOI":"10.3390\/jcm14248772","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T12:57:41Z","timestamp":1765457861000},"page":"8772","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Retrospective Cohort Study on Hassab\u2019s Surgery as a Salvage Treatment for Patients with Secondary Prophylaxis Failure for Acute Variceal Bleeding"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7338-8590","authenticated-orcid":false,"given":"Hongwei","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of General Surgery, Di Tan Hospital, Beijing 100015, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuxue","family":"Xing","sequence":"additional","affiliation":[{"name":"Department of Radiology, Di Tan Hospital, Beijing 100015, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danpu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Di Tan Hospital, Beijing 100015, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rong","family":"He","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Di Tan Hospital, Beijing 100015, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Di Tan Hospital, Beijing 100015, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Di Tan Hospital, Beijing 100015, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2967-475X","authenticated-orcid":false,"given":"Zhe","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Di Tan Hospital, Beijing 100015, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100316","DOI":"10.1016\/j.jhepr.2021.100316","article-title":"Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy","volume":"3","author":"Iwakiri","year":"2021","journal-title":"JHEP Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s12072-017-9826-x","article-title":"Biology of portal hypertension","volume":"12","author":"McConnell","year":"2018","journal-title":"Hepatol. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/hep.28906","article-title":"Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases","volume":"65","author":"Abraldes","year":"2017","journal-title":"Hepatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.cld.2020.04.011","article-title":"Evaluation and Management of EGV in Patients with Cirrhosis","volume":"24","author":"Jakab","year":"2020","journal-title":"Clin. Liver Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2018). EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J. Hepatol., 69, 406\u2013460.","DOI":"10.1016\/j.jhep.2018.08.009"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Korean Association for the Study of the Liver (KASL) (2020). KASL clinical practice guidelines for liver cirrhosis: Varices, hepatic encephalopathy, and related complications. Clin. Mol. Hepatol., 26, 83\u2013127.","DOI":"10.3350\/cmh.2019.0010n"},{"key":"ref_7","unstructured":"Chinese Society of Hepatology, Chinese Society of Gastroenterology, and Chinese Society of Digestive Endoscopology of Chinese Medical Association (2016). Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension Chinese Society of Hepatology. J. Clin. Hepatol., 32, 203\u2013219."},{"key":"ref_8","unstructured":"Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, and Chinese Medical Association (2019). Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension (2019 edition). Chin. J. Dig. Surg., 57, 885\u2013892."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"8839098","DOI":"10.1155\/2020\/8839098","article-title":"Selective Esophagogastric Devascularization in the Modified Sugiura Procedure for Patients with Cirrhotic Hemorrhagic Portal Hypertension: A Randomized Controlled Trial","volume":"2020","author":"Zhang","year":"2020","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1097\/SLA.0b013e31819279cd","article-title":"Prospective validation of the \u201cfifty-fifty\u201d criteria as an early and accurate predictor of death after liver resection in intensive care unit patients","volume":"249","author":"Janny","year":"2009","journal-title":"Ann. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s00535-020-01693-9","article-title":"Treatment outcomes after splenectomy with gastric devascularization or balloon-occluded retrograde transvenous obliteration for gastric varices: A propensity score-weighted analysis from a single institution","volume":"55","author":"Oshita","year":"2020","journal-title":"J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1208614","DOI":"10.1155\/2019\/1208614","article-title":"Elective Splenectomy Combined with Modified Hassab\u2019s or Sugiura Procedure for Portal Hypertension in Decompensated Cirrhosis","volume":"2019","author":"Zhang","year":"2019","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/j.jhep.2021.12.022","article-title":"Baveno VII\u2014Renewing consensus in portal hypertension","volume":"76","author":"Bosch","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Parkash, O., Jafri, W., Munir, S.M., and Iqbal, R. (2018). Assessment of malnutrition in patients with liver cirrhosis using protein calorie malnutrition (PCM) score verses bio-electrical impedance analysis (BIA). BMC Res. Notes, 11.","DOI":"10.1186\/s13104-018-3640-y"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/j.1440-1746.2009.06033.x","article-title":"Factors associated with nutritional status in liver transplant patients who survived the first year after transplantation","volume":"25","author":"Parise","year":"2010","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1002\/hep.28318","article-title":"Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy + beta-blocker for prevention of variceal rebleeding","volume":"63","author":"Holster","year":"2016","journal-title":"Hepatology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e5680","DOI":"10.1097\/MD.0000000000005680","article-title":"Covered TIPS for secondary prophylaxis of variceal bleeding in liver cirrhosis: A systematic review and meta-analysis of randomized controlled trials","volume":"95","author":"Qi","year":"2016","journal-title":"Medicine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1111\/apt.12721","article-title":"Competing risks and prognostic stages of cirrhosis: A 25-year inception cohort study of 494 patients","volume":"39","author":"Pasta","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.jhep.2015.05.022","article-title":"Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension","volume":"63","author":"Faculty","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1016\/j.cgh.2021.01.027","article-title":"AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review","volume":"19","author":"Henry","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8772\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:11:28Z","timestamp":1765458688000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8772"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":20,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248772"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248772","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,12,11]]}}}